The associations of parity and maternal age with small-for-gestational-age,preterm, and neonatal and infant mortality: a meta-analysis

Background

Previous studies have reported on adverse neonatal outcomes associated with parity and maternal age. Many of these studies have relied on cross-sectional data, from which drawing causal inference is complex. We explore the associations between parity/maternal age and adverse neonatal outcomes using data from cohort studies conducted in low- and middle-income countries (LMIC).

Methods

Data from 14 cohort studies were included. Parity (nulliparous, parity 1-2, parity ≥3) and maternal age (<18 years, 18-<35 years, ≥35 years) categories were matched with each other to create exposure categories, with those who are parity 1-2 and age 18-<35 years as the reference. Outcomes included small-for-gestational-age (SGA), preterm, neonatal and infant mortality. Adjusted odds ratios (aOR) were calculated per study and meta-analyzed.

Results

Nulliparous, age <18 year women, compared with women who were parity 1-2 and age 18-<35 years had the highest odds of SGA (pooled adjusted OR: 1.80), preterm (pooled aOR: 1.52), neonatal mortality (pooled aOR: 2.07), and infant mortality (pooled aOR: 1.49). Increased odds were also noted for SGA and neonatal mortality for nulliparous/age 18-<35 years, preterm, neonatal, and infant mortality for parity ≥3/age 18-<35 years, and preterm and neonatal mortality for parity ≥3/≥35 years.

Conclusions

Nulliparous women <18 years of age have the highest odds of adverse neonatal outcomes. Family planning has traditionally been the least successful in addressing young age as a risk factor; a renewed focus must be placed on finding effective interventions that delay age at first birth. Higher odds of adverse outcomes are also seen among parity ≥3 / age ≥35 mothers, suggesting that reproductive health interventions need to address the entirety of a woman’s reproductive period.

Funding

Funding was provided by the Bill & Melinda Gates Foundation (810-2054) by a grant to the US Fund for UNICEF to support the activities of the Child Health Epidemiology Reference Group.

     

Rural youth violence: it is a public health concern!

Youth violence is a significant issue for public health because of the potential for long-term impacts on individuals, families and communities. Limited exposure to violence is seen as a component of healthy living. However, there is limited understanding of violence from a public health perspective within rural communities. Rural refers to those communities with a population less than 10,000 outside the main commuting zone of a large urban area. Population health approaches, including the social determinants of health, are well supported by public health officials. Generating information about rural youth violence from a Canadian perspective would add to our understanding of these social determinants while providing guidance for policy and program development. Current understandings of youth violence are limited to an urban, and oftentimes, American perspective. An ongoing two-phase Canadian study on rural youth violence included qualitative interviews with 52 youth and the completion of a questionnaire that had been developed from the qualitative responses. The questionnaire has been completed by a larger sample of rural youth. The findings generated from this ongoing study will be useful in linking violence with social factors that impact health and thereby guide population health programs and policies. In this way, the role of public health to develop policies and implement programs will be directly influenced by evidence while addressing an ongoing public health concern.     

Cost-of-disease analysis in patients with gastro-oesophageal reflux disease and Barrett's mucosa

BACKGROUND: Gastro-oesophageal reflux disease (GERD) is a common and frequently chronic condition that causes considerable costs. AIM: To estimate the economic burden caused by patients with erosive and non-erosive reflux disease, and Barrett's oesophagus. METHODS: The Progression of Gastro-oesophageal Reflux Disease study includes a total of 6,215 patients. At baseline, patients were categorized as non-erosive reflux disease, erosive reflux disease, or Barrett's oesophagus according to endoscopic findings alone or as confirmed by histology. Direct and indirect disease-related costs were calculated based on 5,273 patients with complete information in the second year of the study. RESULTS: A total of 73% of the Progression of Gastro-oesophageal Reflux Disease patients had taken GERD medication, 61% had visited a doctor, and 2% had been hospitalized because of GERD during the previous 12 months. Of all employed persons, 6% reported days off work because of GERD. This health resource utilization caused direct costs of 342+/-864 (mean+/-s.d.) and indirect costs of 40+/-473 per patient and year. Total costs for patients with Barrett's oesophagus or erosive reflux disease were higher than those for patients with non-erosive reflux disease. CONCLUSION: Patients with GERD frequently need long-term medication and doctor care. The disorder is associated with a considerable health economic burden to society.     

The role of structure activity relationship studies in the search for new GABA uptake inhibitors

gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter in the mammalian central nervous system (CNS). A decrease in GABAergic neurotransmission seems to be involved in neurological pathologies such as epilepsy, anxiety and pain. This review is focus on structure activity relationship studies aiming the search for new GABA uptake inhibitors.     

The spectrum of hepatic functional impairment in compensated chronic hepatitis C: results from the Hepatitis C Anti-viral Long-term Treatment against Cirrhosis Trial

Background The spectrum of functional impairment in patients with compensated chronic hepatitis C is incompletely defined. Aim To define hepatic impairment by quantitative tests (quantitative liver function tests) and correlate results with disease severity in patients with chronic hepatitis C. Methods We studied 285 adult patients with chronic hepatitis C prior to treatment in the Hepatitis C Anti‐viral Long‐term Treatment against Cirrhosis Trial; 171 had Ishak fibrosis stages 2–4 (fibrosis) and 114 had stage 5 or 6 (cirrhosis). None had had clinical decompensation. A battery of 12 quantitative liver function test assessed the spectrum of hepatic microsomal, mitochondrial and cytosolic functions, and hepatic and portal blood flow. Results Twenty‐six to 63% of patients with fibrosis and 45–89% with cirrhosis had hepatic impairment by quantitative liver function test; patients with cirrhosis had the greatest impairment (P‐value ranging from 0.15 to <0.0001). Cholate Cl_oral, cholate shunt and perfused hepatic mass correlated with cirrhosis, stage of fibrosis (r = ?0.51, +0.49, ?0.51), varices and variceal size (r = ?0.39, +0.36, ?0.41). PHM < 95 and cholate shunt >35% identified 91% of patients with medium‐ or large‐sized varices. Conclusions Hepatic impairment is common in compensated patients with fibrosis or cirrhosis because of chronic hepatitis C. Cholate shunt, and cholate Cl_oral and perfused hepatic mass, identify patients at risk for cirrhosis or varices.     

Interventional radiology in the spleen

Despite the widespread use of interventional radiologic techniques, there has been reluctance to apply these to the spleen. Concern for bleeding and difficulty in negotiating around the colon and pleura have limited its use. The authors report their experience with interventional radiology of the spleen in 35 cases, including percutaneous biopsy (n = 5), diagnostic and therapeutic fluid aspiration (n = 14), and catheter drainage of abscesses (n = 9), hematomas (n = 2), intrasplenic pancreatic pseudocysts (n = 2), and necrotic tumor (n = 1). Transsplenic fluid aspiration and biopsy of the pancreas and adrenal gland were performed as well (n = 2). All procedures were performed under computed tomographic or ultrasound guidance. Biopsies were performed with 22- or 20-gauge needles only; no complications were encountered. Diagnoses included primary and secondary malignancies and an infectious process. Drainages were successful in 11 of 14 patients; pleural effusions occurred in two cases, but neither required specific therapy. Interventional radiologic procedures in the spleen are feasible, and the authors discuss methods to promote their safe application.     

Therapy of myocarditis with levamisole

The influence of levamisole on the course of myocarditis was investigated. It was found that levamisole decreased the intensity of subjective symptoms of disease as well as normalised electrocardiographical and immunological changes in greater part of patients.     

The effects of chronic trichloroethylene exposure on neurobehavioral functioning in the rat

Groups of rats were exposed by inhalation to either clean air (Controls) or trichloroethylene at 500, 1000 or 1500 ppm TCE for 16 hr/day, 5 days/week for 18 weeks. At preselected intervals, animals were evaluated for changes in: spontaneous activity, gripstrength, coordinated hindlimb movement, performance of a discrete-trial operant two-choice visual discrimination task, and peripheral nerve conduction velocity. Compared to Controls, TCE-treated rats showed no significant differences in open field behavior, fore- and hindlimb gripstrength or coordinated movement throughout the exposure period. Peripheral nerve conduction time was also unaffected. In contrast, TCE produced progressively marked changes in the speed and patterning of responding in the two-choice visual discrimination task. Two-choice response latency, for example, demonstrated an approximately four-fold increase (p less than 0.001) in the highest dose group. In addition, a recurrent within-week functional tolerance developed for all TCE-exposed groups. However, tolerance was lost in the TCE 1500 group as exposure became chronic. Finally, following the termination of exposure, there was no carry-over of TCE-related effects on any of the measures and performance quickly returned to baseline levels. This profile of effects argues for a primary involvement of the CNS with chronic TCE exposure and is quite unlike that seen with, e.g., n-hexane and carbon disulfide. Such findings underscore the differences in the effects which can be produced by long-term exposure to organic solvents and emphasize the need for a battery of tests in the evaluation of neurotoxicant-induced changes in nervous system functioning.     

A profile of registered nurses in rural and remote Canada.

Research on nursing practice issues in rural and remote areas of Canada is very limited. This report describes the method and initial results of a comprehensive survey of registered nurses (RNs) practising outside the commuting zones of large urban centres, designed to determine: who practises nursing in rural and remote Canada; the nature and scope of their nursing practice; and their satisfaction with their work, community, and practice supports. Using a mailed questionnaire with persistent follow-up, the data-collection frame included a stratified random sample of rural RNs and the full population of RNs who worked in the northern territories and outpost ("remote") settings. The analyses focus on regional comparisons of demographics and primary work settings and on provincial comparisons of satisfaction levels related to work and community. The survey is part of a larger multi-method project intended to inform policy on rural nursing practice in Canada.