Levels of organochlorine pesticides in human milk in Ahmedabad,India

Summary Concentrations of organochlorine compounds, i.e., alpha HCH, gamma HCH, beta HCH, p,p'-DDE, p,p'-DDT, o,p'-DDT; p,p'-DDD and PCBs were determined in 50 human milk samples collected in Ahmedabad, India during 1981–1982. The mothers' ages ranged from 18 to 30 years (mean 24 years), and they were nursing their first or second child. All 50 samples contained alpha-HCH, gamma HCH, beta HCH, p,p'-DDE, and p,p'-DDT in a concentration of 17.51, 1.62, 205.48, 244.71, and 53.43, respectively (median g/kg: whole-milk basis). o,p'-DDT was found in 48 samples whereas p,p'DDD was detected in 44 samples. The concentration of o,p'-DDT and p,p'-DDD was 53.43 and 5.13 g/kg (median), expressed on a whole-milk basis. PCBs were absent in all samples.     

Increased mortality rate associated with chikungunya epidemic, Ahmedabad, India

In 2005-2006, Réunion Island in the Indian Ocean reported approximately 266,000 cases of chikungunya; 254 were fatal (case-fatality rate 1/1,000). India reported 1.39 million cases of chikungunya fever in 2006 with no attributable deaths; Ahmedabad, India, reported 60,777 suspected chikungunya cases. To assess the effect of this epidemic, mortality rates in 2006 were compared with those in 2002-2005 for Ahmedabad (population 3.8 million). A total of 2,944 excess deaths occurred during the chikungunya epidemic (August-November 2006) when compared with the average number of deaths in the same months during the previous 4 years. These excess deaths may be attributable to this epidemic. However, a hidden or unexplained cause of death is also possible. Public health authorities should thoroughly investigate this increase in deaths associated with this epidemic and implement measures to prevent further epidemics of chikungunya.     

Risk factors for preterm and term low birthweight in Ahmedabad, India.

To identify and quantify risk factors for preterm and term low birthweight (LBW) we conducted a hospital-based case-control study, linked with a population survey in Ahmedabad, India. The case-control study of 673 term LBW, 644 preterm LBW cases and 1465 controls showed that low maternal weight, poor obstetric history, lack of antenatal care, clinical anaemia and hypertension were significant independent risk factors for both term and preterm LBW. Short interpregnancy interval was associated with an increased risk of preterm LBW birth while primiparous women had increased risk of term LBW. Muslim women were at a reduced risk of term LBW, but other socioeconomic factors did not remain significant after adjusting for these more proximate factors. Estimates of the prevalence of risk factors from the population survey was used to calculate attributable risk. This analysis suggested that a substantial proportion of term and preterm LBW births may be averted by improving maternal nutritional status, anaemia and antenatal care.     

Screening for gestational diabetes,Ahmedabad, India

ObjectiveTo implement a community-based screening and awareness-raising project for gestational diabetes in Ahmedabad, India.MethodsThe project took place between April 2016 and August 2019 in Ahmedabad. Medical college faculty members and medical officers trained 3582 paramedical staff on screening for gestational diabetes. These paramedical staff tested all pregnant women 24–28 weeks gestation, who were attending village health and nutrition days – also called mamta days – in urban and rural health centres for routine antenatal care, for gestational diabetes. An oral glucose tolerance test was used and blood sugar ≥ 7.8 mmol/L was the cut-off for gestational diabetes. Women with gestational diabetes were referred for counselling and treatment and all women were followed until 6 weeks after delivery.FindingsOf 53 522 pregnant women screened, 6786 (12.7%) had gestational diabetes and were referred for nutritional therapy or medication; 836 (12.3%) of these women started medication. There was no significant difference in the prevalence of stillbirths between women with gestational diabetes (0.8%; 54/6786) and women without (0.7%; 338/46 736; P-value: 0.51). Of the women on treatment, 38 had abnormal blood glucose after delivery and continued with the medication. Two women with gestational diabetes died; they had other associated co-morbidities – pre-eclampsia and anaemia.ConclusionWe found a high prevalence of gestational diabetes, indicating the need for gestational diabetes screening and implementation of this project on a larger scale. Gestational diabetes screening at the community level is operationally feasible using the existing human resources and infrastructure of the reproductive health programmes.     

Labour complications remain the most important risk factors for perinatal mortality in rural Kenya

OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting.     

Searching for socioeconomic risk factors in perinatal mortality in Kuwait: a case control study

The aim of this paper was to investigate whether socioeconomic factors such as parent's education, occupation, and income constitute risk factors in perinatal mortality after controlling for biological variables such as birth weight and length of gestation, and maternal factors such as age, parity and reproductive history. A case-control study covering all perinatal deaths in Kuwait was conducted for one year from 1 October, 1997 to 30 September, 1998. Each case (perinatal death) was matched with a control (live birth). Matching criteria were: father's nationality, place, and date of birth. Information was successfully collected on 463 matched pairs, 274 Kuwaitis and 189 non-Kuwaitis. Only singleton births were included in the analysis. Bivariate analysis showed that several of the socioeconomic variables (e.g. lower education, lower income) increased the risk of a perinatal death. However, none of these variables remained significant in the multivariate analysis in which birth weight and length of gestation emerged as the two major determinants of perinatal deaths among both nationality groups. Among the Kuwaitis, primiparity and high parity, and previous history of miscarriage were also significant risk factors. Among the non-Kuwaitis, none of the socioeconomic factors, or the maternal factors, were significant predictors of perinatal mortality. For Kuwaitis, it appears that the government's policies and programs aimed at reducing social inequalities in the society have been effective in eliminating perinatal mortality differences between socioeconomic groups. Among non-Kuwaitis, the lack of differences is reflective of the fact that this group is relatively homogenous and selective of the more affluent who can bring the family to Kuwait. Both nationality groups benefit from the government's free health services. However, charges for non-Kuwaitis are due to be levied soon which may increase disparities in access to health care.     

Risk factors for perinatal mortality in Recife, Pernambuco State, Brazil, 2003

The aim of this study was to identify and analyze risk factors for perinatal mortality in Recife, Pernambuco State, Brazil, in 2003, using a multilevel hierarchical model. In this case-control study, cases consisted of all perinatal deaths in 2003 in singleton infants with birth weight > 500g and without congenital malformations. The controls were live births from December 26, 2002, to December 31, 2003, with the same characteristics as the study group, but who survived > 6 days. By using record linkage techniques, 403 cases and 1,612 controls were obtained. All variables, when submitted jointly to multiple logistic regression, showed statistical significance in decreasing order of risk, as follows: prematurity (OR = 18.23), low birth weight (OR = 4.90), maternal age > 35 (OR = 1.97), delivery in public hospitals (OR = 1.93), and maternal schooling < 4 years (OR = 1.78).     

Air Nicotine Levels in Public Places in Ahmedabad,India: Before and After Implementation of the Smoking Ban

Aim:

To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008.

Materials and Methods:

Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration.

Results:

Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m³ Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m³ IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m³ at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160).

Conclusion:

Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban.     

Prevalence of byssinosis in textile mills at Ahmedabad, India

In an epidemiological study carried out in three textile mills at Ahmedabad, India, 929 workers were examined from the spinning departments. The mean prevalence of byssinosis in the blow section was 29.62%, whereas in the card section it was 37.83%. The concentrations of cotton dust (dust less fly) were high in the blow and card sections (4.00 mg/m3 in the blow and 3.06 mg/m3 in the card section). This study suggests that the prevalence of byssinosis is not low in the textile mills of India as reported in many earlier Indian studies.     

Temporal changes in the distribution of population risk factors attenuate the reduction in perinatal mortality

BACKGROUND AND OBJECTIVE: To examine and quantify the changing contribution of some risk factors to the perinatal mortality rate. METHODS: A population-based retrospective cohort study in Northern England compared stillbirth, neonatal, and perinatal mortality rates by birthweight, maternal age, plurality, and gender between 1982-1990 and 1991-2000. RESULTS: Atlhough the perinatal mortality rate fell by 20% between 1982-1990 and 1991-2000, the proportion of births in high risk groups (low and high birthweight, older mothers, and multiple births) increased. Standardizing the rates for 2000 to the risk factor distribution in 1982 resulted in lower rates. Changes in the birthweight distribution had the largest impact, particularly on neonatal mortality. Nearly a quarter of neonatal deaths in Northern England in 2000 can be attributed to the shift in the birthweight distribution since 1982, especially to the increase in low birthweight births. CONCLUSION: Changes in the distribution of birthweight, maternal age, and plurality over the study period attenuated the observed reduction in perinatal mortality. It is important to consider differences in the population prevalence of such risk factors to make valid geographic or temporal comparisons. Reasons for the secular shift in birthweight and the implications of any contributing change in obstetric practice require further investigation.     

Prevalence of byssinosis in textile mills at Ahmedabad, India.

In an epidemiological study carried out in three textile mills at Ahmedabad, India, 929 workers were examined from the spinning departments. The mean prevalence of byssinosis in the blow section was 29.62%, whereas in the card section it was 37.83%. The concentrations of cotton dust (dust less fly) were high in the blow and card sections (4.00 mg/m3 in the blow and 3.06 mg/m3 in the card section). This study suggests that the prevalence of byssinosis is not low in the textile mills of India as reported in many earlier Indian studies.     

孕期和围产期危险因素对儿童发育性运动协调障碍影响的研究

目的探讨发育性运动协调障碍(DCD)的孕产期和围产期危险因素,为其病因学研究以及早期预防提供依据。方法在苏州市区随机整群抽取1 5个幼儿园160个班级共4 001名儿童.采用儿童运动成套评估工具(M-ABC)对DCD筛杏和确诊,采用多水平logistic回归模型和结构方程模型分析DCD危险因素。结果多水平logistic同归模型分析显示,在控制班级群内聚集性以及儿童性别、年龄、Kaup指数情况下,急性胎儿宫内窘迫史、早产史、新生儿期病理性黄疸史纳入模型,差异有统计学意义(OR值分别为7.030、3.374、1.993,P值均结论孕期和围产期危险因素对儿童DCD存在影响。