Concentrations of organochlorine pesticides in milk of Nicaraguan mothers

Breast-milk samples from 101 mothers from the basin of Rio Aloya, Nicaragua, were collected on two occasions within the first trimester of lactation. Milk samples were analyzed for 13 organochlorine pesticides: (1) p,p'-dichlorophenyldichloroethylene; (2) p,p'-dichlorophenyltrichloroethane; (3) p,p'-dichlorophenyldichlorodiene; (4) alpha-hexachlorocyclohexane; (5) beta-hexachlorocyclohexane; (6) gamma-hexachlorocyclohexane; (7) delta-hexachlorocyclohexane; (8) toxaphene; (9) dieldrin; (10) endrin; (11) aldrin; (12) heptachlor; and (13) heptachlor-epoxide. Organochlorines of the dichlorodiphenylethane class (i.e., p,p'-dichlorodiphenylethane and p,p'-dichlorodiphenylethane) were found in all samples and at the highest mean concentrations observed in the study. Chemicals in the hexachlorocyclohexane family (i.e., alpha- and delta-hexachlocyclohexane) were not found at all (0%), and the other hexachlorocyclohexane compounds (i.e., beta > gamma) were found in less than 6% of the samples. Twenty percent or less of the sample contained chlorInated cyclodienes (i.e., dieldrin > endrin > heptachlor-epoxide > heptachlor). No measurable concentrations of alpha-hexachlorocyclohexane, aldrin, p,p'-dichlorophenyldichlorodiene, and toxaphene were found in the breast milk samples. Analysis of variance demonstrated that only the concentration of p,p'-dichlorophenyldichloroethylene p,p'-dichlorophenyltrichloroethane, and endrin were affected significantly by maternal age. Overall, with the exception of p,p'-chlorophenyldichloroethylene, and p,p'-dichlorophenyltrichloroethane, the mean concentrations of the analyzed pesticides were low. Total p,p'-dichlorophenyltrichloroethane concentrations that exceeded the allowed daily intake set by the World Health Organisation were found in 5.9% of the samples.     

Perinatal morbidity and mortality in offsprings of diabetic mothers in Qatif, Saudi Arabia

Diabetic mothers and their offsprings were prospectively studied. Perinatal and neonatal morbidity and mortality data were analysed. The 133 deliveries by diabetic mothers constituted 1.14% of 11677 deliveries in the hospital. They were made up of six (4.5%) stillbirths and 127 (95.5%) live births. Seventy seven (57.9%), 55 (41.3%) and one (0.8%) were large, appropriate and small for gestational age respectively. Hypoglycemia occurred in 49 (38.6%) of the 127 live birth infants. Other associated problems were bacterial infections, cogenital anomalies, birth trauma, preterm delivery, respiratory distress, polycythaemia, and anaemia. Only 52 (39.1%) of the mothers received appropriate treatment for their diabetes. Poor maternal diabetic control resulted in high perinatal morbidity and mortality in the offsprings. In order to improve the outcome in offsprings of diabetic mothers in Qatif and probably Saudi Arabia as a whole health education and improved coverage of the diabetic mothers during pregnancy are urgently needed. This may be true of many developing countries where data on diabetes in pregnancy are scarce.     

四川省HIV感染孕产妇所生围产儿死亡现状与影响因素研究

目的 了解HIV感染孕产妇所生围产儿死亡情况,探讨影响围产儿死亡的因素,为降低四川省HIV感染孕产妇所生围产儿死亡水平和减少艾滋病母婴传播提供参考依据。方法 在四川省2005－2016年开展预防艾滋病母婴传播的183个县（市、区）医疗保健机构,选取HIV感染孕产妇4 734例及其所生围产儿4 786例作为研究对象。收集其母亲孕产期及围产儿相关流行病学调查资料,采用单因素χ²检验和多因素logistic回归,分析围产儿死亡情况及其影响因素。结果 HIV感染孕产妇所生围产儿死亡率为25.7‰（123/4 786）,呈逐年下降趋势（趋势χ²=32.220,P=0.000）,凉山州围产儿死亡率高于四川省其他地区（χ²=4.130,P=0.042）,凉山州死胎/死产较多、四川省其他地区7 d内死亡较多（χ²=29.626,P=0.000）。多因素logistic回归分析结果显示,母亲怀孕1~2次及3~4次的围产儿死亡率低于怀孕≥5次者（1~2次的OR=0.417,95% CI：0.184~0.943;3~4次的OR=0.447,95% CI：0.223~0.895）,孕产期使用基于以洛匹那韦/利托那韦（克力芝,LPV/r）为主的蛋白酶抑制剂（PI）三联抗病毒治疗方案的HIV感染孕产妇所生围产儿更容易避免死亡（OR=0.530,95% CI：0.285~0.986）,医疗机构分娩的围产儿死亡率低于家中或途中分娩者（市级及以上助产机构OR=0.222,95% CI：0.098~0.499;县级助产机构OR=0.282,95% CI：0.166~0.480;乡级助产机构OR=0.134,95% CI：0.031~0.586）,早产、新生儿窒息导致围产儿死亡的危险性增加（早产OR=8.285,95% CI：5.073~13.533;新生儿窒息OR=9.624,95% CI：4.625~20.028）。结论 四川省HIV感染孕产妇所生围产儿死亡率远高于全国、四川省孕产妇所生围产儿死亡率,应减少HIV感染孕产妇的孕次、采用基于LPV/r的三联抗病毒治疗方案,提倡住院分娩,减少围产儿发生早产和新生儿窒息。     

Perinatal outcomes among immigrant mothers over two periods in a region of central Italy

Background

The number of immigrants has increased in Italy in the last twenty years (7.2% of the Italian population), as have infants of foreign-born parents, but scanty evidence on perinatal outcomes is available. The aim of this study was to investigate whether infants of foreign-born mothers living in Italy have different odds of adverse perinatal outcomes compared to those of native-born mothers, and if such measures changed over two periods.

Methods

The source of this area-based study was the regional hospital discharge database that records perinatal information on all births in the Lazio region. We analysed 296,739 singleton births born between 1996-1998 and 2006-2008. The exposure variable was the mother's region of birth. We considered five outcomes of perinatal health. We estimated crude and adjusted odds ratios and 95% confidence intervals (CIs) to evaluate the association between mother's region of birth and perinatal outcomes.

Results

Perinatal outcomes were worse among infants of immigrant compared to Italian mothers, especially for sub-Saharan and west Africans, with the following crude ORs (in 1996-1998 and 2006-2008 respectively): 1.80 (95%CI:1.44-2.28) and 1.95 (95%CI:1.72-2.21) for very preterm births, and 1.32 (95%CI:1.16-1.50) and 1.32 (95%CI:1.25-1.39) for preterm births; 1.18 (95%CI:0.99-1.40) and 1.17 (95%CI:1.03-1.34) for a low Apgar score; 1.22 (95%CI:1.15-1.31) and 1.24 (95%CI:1.17-1.32) for the presence of respiratory diseases; 1.47 (95%CI:1.30-1.66) and 1.45 (95%CI:1.34-1.57) for the need for special or intensive neonatal care/in-hospital deaths; and 1.03 (95%CI:0.93-1.15) and 1.07 (95%CI:1.00-1.15) for congenital malformations. Overall, time did not affect the odds of outcomes differently between immigrant and Italian mothers and most outcomes improved over time among all infants. None of the risk factors considered confounded the associations.

Conclusion

Our findings suggest that migrant status is a risk factor for adverse perinatal health. Moreover, they suggest that perinatal outcomes improved over time in some immigrant women. This could be due to a general improvement in immigrants' health in the past decade, or it may indicate successful application of policies that increase accessibility to mother-child health services during the periconception and prenatal periods for legal and illegal immigrant women in Italy.

     

Time-dependent toxicity of dichlorodiphenyldichloroethylene to Hyalella azteca

Temporal effects on body residues of dichlorodiphenyldichloroethylene (DDE) associated with mortality in the freshwater amphipod Hyalella azteca were evaluated. Toxicokinetics and body residues were determined from water-only exposures that varied from 4 to 28 d, and DDE concentrations ranging from 0.0013 to 0.045 micromol L(-1). Uptake and elimination parameters were not affected significantly by the various temporal and concentration treatments. Uptake rate coefficients ranged from 134.3 to 586.7 ml g(-1) h(-1), and elimination rate coefficients ranged from 0.0011 to 0.0249 h(-1). Toxicity metric values included body residue for 50% mortality at a fixed sample time (LR50) and mean lethal residue to produce 50% mortality from individual exposure concentrations (MLR50) for live organisms and dead organisms. A twofold increase occurred in the MLR50 values calculated using live organisms compared to MLR50 values using dead organisms. Toxicity and kinetic data were fit to a damage assessment model that allows for the time course for toxicokinetics and damage repair, demonstrating the time-dependence of body residues to toxicity. The DDE appeared to act through a nonpolar narcosis mode of action for both acute and chronic mortality in H. azteca. Furthermore, the temporal trend in the toxic response using body residue as the dose metric is steep and found to be similar to another chlorinated hydrocarbon, pentachlorobenzene, but was more potent than that found for polycyclic aromatic hydrocarbons (PAHs).     

Perinatal low-protein diet alters brainstem antioxidant metabolism in adult offspring

Background and objectives: Studies in humans and animal models have established a close relationship between early environment insult and subsequent risk of development of non-communicable diseases, including the cardiovascular. Whereas experimental evidences highlight the early undernutrition and the late cardiovascular disease relation, the central mechanisms linking the two remain unknown. Owing to the oxidative balance influence in several pathologies, the aim of the present study was to evaluate the effects of maternal undernutrition (i.e. a low-protein (LP) diet) on oxidative balance in the brainstem.

Methods and results: Male rats from mothers fed with an LP diet (8% casein) throughout the perinatal period (i.e. gestation and lactation) showed 10× higher lipid peroxidation levels than animals treated with normoprotein (17% casein) at 100 days of age. In addition, we observed the following reductions in enzymatic activities: superoxide dismutase, 16%; catalase, 30%; glutathione peroxidase, 34%; glutathione-S-transferase, 51%; glutathione reductase, 23%; glucose-6-phosphate dehydrogenase, 31%; and in non-enzymatic glutathione system, 46%.

Discussion: This study is the first to focus on the role of maternal LP nutrition in oxidative balance in a central nervous system structure responsible for cardiovascular control in adult rats. Our data observed changes in oxidative balance in the offspring, therefore, bring a new concept related to early undernutrition and can help in the development of a new clinical strategy to combat the effects of nutritional insult. Wherein the central oxidative imbalance is a feasible mechanism underlying the hypertension risk in adulthood triggered by maternal LP diet.     

Prenatal dichlorodiphenyldichloroethylene (DDE) and asthma in children

Prevalence of asthma increases with increasing dichlorodiphenyldichloroethylene (DDE) levels. However, the effect of early-life exposure, the fundamental window of exposure, is unknown. We assessed the association between prenatal DDE and other organochlorine compounds, and atopy and asthma during infancy. All women presenting for antenatal care in Menorca (Spain) over 12 months starting in mid-1997 were invited to take part in a longitudinal study; 482 children were subsequently enrolled, and 468 (97.1%) provided complete outcome data up to the fourth year of study. Prenatal exposure of organochlorine compounds was measured in cord serum in 405 (83%) children. Asthma was defined on the basis of wheezing at 4 years of age, persistent wheezing, or doctor-diagnosed asthma. We measured specific immunoglobulin-E (IgE) against house dust mite, cat, and grass in sera extracted at 4 years of age. DDE (median = 1.03 ng/mL) was detected in all children, as well as hexachlorobenzene (0.68 ng/mL) and polychlorobiphenyls (0.69 ng/mL). Wheezing at 4 years of age increased with DDE concentration, particularly at the highest quartile [9% in the lowest quartile (< 0.57 ng/mL) vs. 19% in the highest quartile (1.90 ng/mL); relative risk = 2.63 (95% confidence interval 1.19-4.69), adjusting for maternal asthma, breast-feeding, education, social class, or other organochlorines]. The association was not modified by IgE sensitization and occurred with the same strength among nonatopic subjects and among those with persistent wheezing or diagnosed asthma. DDE was not associated with atopy alone. Prenatal exposure to DDE residues may contribute to development of asthma.     

Perinatal mental health in lesbian mothers: a review of potential risk and protective factors

Postpartum depression and other perinatal mental illnesses are common complications of childbirth. The majority of research on these conditions has been conducted in heterosexual women; however, increasing numbers of women are choosing to parent in the context of lesbian relationships. Although many of the fundamental aspects of the transition to parenthood are shared between lesbian and heterosexual mothers, lesbian mothers may differ from heterosexual parents on a number of variables that have been previously associated with perinatal mental health. Lesbian mothers may be more likely than their heterosexual peers to lack social support, particularly from their families of origin, and may be exposed to additional stress due to homophobic discrimination. However, the likelihood that lesbian pregnancies will be planned, together with the relatively equal division of child-care labour observed in lesbian couples, may offer protection from perinatal depression. The study of perinatal mental health in lesbian mothers is warranted, both to ensure that the mental health needs of this largely invisible population are being met, and to further illuminate the role of psychosocial stress in perinatal mental health in all women.     

Perinatal vitamin D and calcium status of northern Canadian mothers and their newborn infants

OBJECTIVE: This study was undertaken to examine the vitamin D and calcium status of mothers and their newborns. METHODS: The intakes of vitamin D and calcium were determined prenatally in 121 women including 33 Caucasians, 51 Inuits, and 37 Native Indians, living in the Inuvik zone of the Northwest Territories. Plasma concentrations of 25-(OH)-D and calcium were also measured in mothers as well as in their offspring at delivery. RESULTS: The daily mean vitamin D intake of native mothers, including Inuits and Indians, with (8.1+/-5.5 microg) and without supplements (3.4+/-2.5 microg) was significantly lower than that of non-native mothers (13.2+/-5.9 microg and 5.8+/-4.3 microg, respectively). According to the predicted prevalence of low vitamin D intake, there existed a higher risk of vitamin D deficiency without supplementation in both native (88.6% vs 48.4%) and non-native (63.5% vs. 15.1%) mothers. The trend for calcium intakes with and without supplementation was similar to vitamin D intake. At the point of delivery, the plasma levels of 25-(OH)-D were lower in native mothers (50.1 19.3 nmol/L) and their offspring (34.2+/-13.1 nmol/L) than their counterparts (59.8+/-29.4 nmol/L and 41.4+/-23.5 nmol/L, respectively). Its plasma levels in newborn infants averaged only 67% of their mothers. None of these infants showed clinical evidence of vitamin D deficiency. In fact, their plasma calcium levels were significantly higher than their mothers. CONCLUSIONS: Plasma 25-(OH)-D concentrations of 60 to 70% of maternal levels may represent a "normal" range for newborn infants. However, a supplementation in native northern Canadian mothers during pregnancy and in their neonates during infancy may have a role to play in the prevention of vitamin D deficiency.     

Perinatal mortality in rural Malawi.

Reported are the results of a study to assess the prevalence and risk factors for perinatal death among pregnant women in Malawi over the period 1987-90. There were 264 perinatal deaths among the 3866 women with singleton pregnancies (perinatal mortality rate, 68.3 per 1000 births). Among the risk factors for perinatal mortality were the following: reactive syphilis serology, nulliparity, a late fetal or neonatal death in the most recent previous birth, maternal height < 150 cm, home delivery, and low socioeconomic status. Although unexplained perinatal deaths will continue to occur, perinatal mortality can be reduced if its causes and risk factors in a community are given priority in antenatal and intrapartum care programmes. The following interventions could potentially reduce the perinatal mortality in the study population: screening and treating women with reactive syphilis serology; and management from early labour, by competent personnel in a health facility, of nulliparous women and multiparous women who are short or have a history of a perinatal death.     

Concentrations of Organochlorine Pesticides in Milk of Nicaraguan Mothers

Breast-milk samples from 101 mothers from the basin of Rio Atoya, Nicaragua, were collected on two occasions within the first trimester of lactation. Milk samples were analyzed for 13 organochlorine pesticides: (1) p,p'-dichlorophenyldichloroethylene; (2) p,p'-dichlorophenyltrichloroethane; (3) p,p'-dichlorophenyldichlorodiene; (4) α-hexachlorocyclohexane; (5) β-hexachlorocyclohexane; (6) γ-hexachlorocyclohexane; (7) δ-hexachlorocyclohexane; (8) toxaphene; (9) dieldrin; (10) endrin; (11) aldrin; (12) heptachlor; and (13) heptachlor-epoxide. Organochlorines of the dichlorodiphenylethane class (i.e., p,p'-dichlorodiphenylethane and p,p'-dichlorodiphenylethane) were found in all samples and at the highest mean concentrations observed in the study. Chemicals in the hexachlorocyclohexane family (i.e., α- and δ-hexachlorocyclohexane) were not found at all (0%), and the other hexachlorocyclohexane compounds (i.e., β > γ) were found in less than 6% of the samples. Twenty percent or less of the sample contained chlorinated cyclodienes (i.e., dieldrin > endrin > heptachlor-epoxide > heptachlor). No measurable concentrations of α-hexachlorocyclohexane, aldrin, p,p'-dichlorophenyldichlorodiene, and toxaphene were found in the breast milk samples. Analysis of variance demonstrated that only the concentration of p,p'-dichlorophenyldichloroethylene p,p'-dichlorophenyltrichloroethane, and endrin were affected significantly by maternal age. Overall, with the exception of p,p'-chlorophenyldichloroethylene, and p,p'-dichlorophenyltrichloroethane, the mean concentrations of the analyzed pesticides were low. Total p,p'-dichlorophenyltrichloroethane concentrations that exceeded the allowed daily intake set by the World Health Organisation were found in 5.9% of the samples.     

Health personnel training in the Nicaraguan health system

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.     

Perinatal immunoprophylaxis in babies born to hepatitis B virus-positive mothers in Queensland Australia: A data linkage study

Vertical transmission from mother-to-child is an important mode of hepatitis B virus (HBV) infection, accounting for up to half of all incident cases globally. We evaluated the uptake of HBV neonatal vaccination and immunoglobulin delivery in Queensland, Australia, between 2001 and 2013. We identified HBV-positive mothers using linked notifiable conditions, hospitalisation, and perinatal administrative data. Perinatal receipt of monovalent HBV vaccine and hepatitis B immunoglobulin were examined. Of 710,859 live births, with 5753 infants (0.81%) born to identified HBV-positive mothers; 91.7% received HBV neonatal vaccine. Immunoglobulin uptake was 20.0% in 2012 and 36.6% in 2013. Uptake was higher when the mother’s HBV-positive status was recorded in perinatal records (69.6% if maternal HBV status recorded on perinatal data collection vs 9.5% otherwise). Delivery of neonatal HBV vaccination in Queensland was high. Improved identification and documentation of HBV-positive mothers’ status during the antenatal period was associated with increased immunoglobulin administration.     

Changes in kidney function among Nicaraguan sugarcane workers

Abstract

Background:

There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers.

Objectives:

To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria.

Methods:

We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR).

Results:

eGFR varied by job and decreased during the harvest in seed cutters (?8·6 ml/min/1·73 m²), irrigators (?7·4 ml/min/1·73 m²), and cane cutters (?5·0 ml/min/1·73 m²), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g.

Conclusions:

The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.     

Changes in kidney function among Nicaraguan sugarcane workers

Background:

There is an epidemic of chronic kidney disease (CKD) of unknown etiology in Central American workers.

Objectives:

To investigate changes and job-specific differences in kidney function over a 6-month sugarcane harvest season, explore the potential role of hydration, and measure proteinuria.

Methods:

We recruited 284 Nicaraguan sugarcane workers performing seven distinct tasks. We measured urine albumin and serum creatinine and estimated glomerular filtration rate (eGFR).

Results:

eGFR varied by job and decreased during the harvest in seed cutters (−8.6 ml/min/1.73 m²), irrigators (−7.4 ml/min/1.73 m²), and cane cutters (−5.0 ml/min/1.73 m²), as compared to factory workers. The number of years employed at the company was negatively associated with eGFR. Fewer than 5% of workers had albumin-to-creatinine ratio (ACR) >30 mg/g.

Conclusions:

The decline in kidney function during the harvest and the differences by job category and employment duration provide evidence that one or more risk factors of CKD are occupational.     

Reference spirometric values in healthy Nicaraguan male workers

The main objective was to derive reference equations for the FVC, FEV₁, and FEV₁/FVC ratio for healthy Nicaraguan male workers without current occupational exposure to agents hazardous to the lungs. Age, height, and weight were included as independent variables in the analysis, but only age and height showed significant effects on the indices studied. A nonlinear relationship with age was observed for FVC and FEV₁, with a shift in the slope at the age of 32 years. Linear, quadratic, and multiphase models were tested in order to assess the best reference equation. The multi-phase model most closely fitted the values measured. The FEV₁/FVC ratio showed a significant linear negative correlation with age. A comparison between the equations derived from this material and those reported in other studies revealed substantial differences. Racial, genetic, nutritional, work and sociocultural factors could account for the differences. © 1996 Wiley-Liss, Inc.