Factors associated with infant and adolescent mortality

Lifetime overweight and adult asthma: 1978/1979 Ribeirão Preto Birth Cohort, São Paulo, Brazil

Studies focusing on obesity and asthma frequently consider the weight at a given time; thus, modeling pathways through lifetime overweight may contribute to elucidate temporal aspects in this relationship. This study modeled the pathways in the association of lifetime overweight with asthma in adult life, using data from the 1978/1979 Birth Cohort, Ribeirão Preto, São Paulo, Brazil (n = 2,063) at birth (baseline), school age (9/11 years) and adult age (23/25 years). A theoretical model was proposed to explore the effects of lifetime overweight on asthma in adult life analyzed by structural equation modeling. Parental obesity (SC - standardized coefficenttotal = 0.211, p < 0.001; SCdirect = 0.115, p = 0.007) and overweight at school age (SCtotal = 0.565, p < 0.0001; SCdirect = 0.565, p < 0.0001) were associated with overweight in adult life. Parental obesity (SCdirect = 0.105, p = 0.047) and nutritional status at birth (SCtotal = -0.124, p = 0.009; SCdirect = -0.131, p = 0.007) were associated with asthma in adult life. A higher "current adult socieconomic situation" was inversely associated to overweight (SCdirect = -0.171, p = 0.020) and to asthma in adult life (SCtotal = -0.179, p = 0.041; SCdirect = -0.182, p = 0.039). Parental obesity showed a transgenerational effect in weight, triggering to childhood and adulthood overweight. Parallel to underweight at birth, parental obesity was also a risk to asthma in adult life. While, the socioeconomic status in adult life protected from both, overweight and asthma.

A descriptive medico-legal study of female deaths in cairo governorate, Egypt

BACKGROUND

Mortality is conditioned by biological, political and social factors, as well as by culturally defined behaviors and attitudes that historically characterize the stage of development of a country or a region. Women are often in great danger, where they should be safest. Violence against women is the most pervasive yet the least recognized human rights violation in the world. It is a profound health problem and femicide, is often the tragic end-point of violence. Females represent more than half of the Egyptian population, however, they remain vulnerable.

AIM OF THE STUDY

To describe and analyze data obtained from Zeinhom Morgue records in Cairo, regarding female deaths, throughout two years. To evaluate female deaths regarding age, cause, manner of death, location, perpetrator and motive. To describe the incidence of female homicides and their related injury patterns. To identify the risk factors and nature of violence from victimologic point of view. Finally, to describe the manner of death whether natural, homicidal, suicidal or accidental aiming for early identification of vulnerable females so that actions can be taken to prevent further mortality.

SUBJECTS AND METHODS

This is a national two year retrospective descriptive mortuary based study. The study population comprised of all adult females, aged 18 years and older, whose death was suspicious and medico-legal examination was ordered. Each investigation included a detailed case history, investigation, gross examination, histo-pathological and toxicological examinations. Data was collected from autopsy reports, hospital records and police records. From the available data the victim profile was made.

RESULTS

All female deaths aged 18 years and older were retrospectively reviewed for 2 years at Zeinhom morgue of Medico-legal Authority from a total of 1858 autopsy cases. The most common manner of death was homicide. The commonest cause of death in homicides was due to sharp traumatic injuries. Natural death was the least common manner of death and ischemic heart disease constituted the commonest cause. Falling from height was the most common method of suicidal related deaths. Regarding poisoned cases, insecticides and carbon monoxide were the most common detected poisons. According to the cause of death (trauma), blunt trauma injuries were the most common. Falling from height constituted the largest percent of cases under this group.

CONCLUSION AND RECOMMENDATIONS

Females in the third decade of life with blunt injuries to the head and neck were the majority of adult female autopsies. Homicide was the most common manner of female death using sharp instruments after domestic arguments mainly by a spouse or relative. Accidental death came second mainly due to post-operative complications. In cases of suicide, falling from height was the commonest cause followed by poisoning. These findings could be useful for forensic pathologists and healthcare promoters in predicting and preventing female deaths. Moreover, this emphasizes the need for raising public awareness about the scale of female violence problem in our society. The results of this study indicates that, by not only a strong legal support network, but also by opportunities for economic independency, essential education and awareness, alternative accommodation and a change in attitude and mindset of society, judiciary, legislature, executive, men and most importantly women themselves can lower or even prevent such deaths specially suicidal.

[Accidents and violence in childhood and adolescence: risk and protective factors]

Singled out by statistics as the third leading cause of mortality in our country, external causes (accidents and violence) entail a great impact with economic, social and emotional rebound. Knowing the factors related to the event is essential, because it allows identifying and breaking the web that determines morbidity and mortality from external causes. The study aims to analyze the existing publications on the factors associated with accidents and violence, in order to provide theoretical support for professionals in their practices. This is a bibliographical study of the Liliacs, Medline and Scielo databanks. The knowledge of the risk and protection factors discussed in the present study enables subsidize the practice of social actors engaged in transforming the conditions that lead to accidents and violence.

Cesarean Section Is Associated with Increased Peripheral and Central Adiposity in Young Adulthood: Cohort Study

BACKGROUND

Cesarean section (CS) has been associated with obesity, measured by body mass index (BMI), in some studies. It has been hypothesized that this association, if causal, might be explained by changes in gut microbiota. However, little is known about whether CS is also associated with increased adiposity as measured by indicators other than BMI.

OBJECTIVE

To assess the association between CS and indicators of peripheral and central adiposity in young adults.

METHODS

The study was conducted on 2,063 young adults aged 23 to 25 years from the 1978/79Ribeirão Preto birth cohort, São Paulo, Brazil. CS was the independent variable. The anthropometric indicators of adiposity were: waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), tricipital skinfold (TSF), and subscapular skinfold (SSF). The association between CS and indicators of adiposity was investigated using a Poisson model, with robust adjustment of variance and calculation of incidence rate ratio (IRR) with 95% confidence interval (95%CI), and adjustment for birth variables.

RESULTS

Follow-up rate was 31.8%. The CS rate was 32%. Prevalences of increased WC, WHtR, WHR were 32.1%, 33.0% and 15.2%, respectively. After adjustment for birth variables, CS was associated with increased risk of adiposity when compared to vaginal delivery: 1.22 (95%CI 1.07; 1.39) for WC, 1.25 (95%CI 1.10;1.42) for WHtR, 1.45 (95%CI 1.18;1.79) for WHR, 1.36 (95%CI 1.04;1.78) for TSF, and 1.43 (95%CI 1.08;1.91) for SSF.

CONCLUSION

Subjects born by CS had a higher risk for increased peripheral and central adiposity during young adult age compared to those born by vaginal delivery. The association of CS with adiposity was consistently observed for all indicators and was robust after adjustment for a variety of early life confounders.

Deaths from external causes in Cuiabá, 0 a 24 years: Profile of victims and families according to intentionality

In view of the importance of knowing the circumstances associated with external causes (accidents and violence), this study analyzes the profile of the victims and their families as to the intentionality of the event (intentional or accidental). Cross-sectional study, which population comprise children, adolescents, and young people (age 0 to 24) who lived in Cuiabá, MT, and died from external causes in 2009. The data, processed by the Epi-Info software, were taken from the Declarations of Death and interviews with the families of the victims. The nonparametric chi-square test showed statistically significant differences between accidental and intentional deaths by sex and the type of accident or violence, the occurrence of the previous event external cause, parental education, family type, income, responsible for supporting the house, mother's age and caregiver. Among the victims, male participation (88.7 %) stands out compared to female (11.3 %). 50.0% of the deaths of females were accidental and 50.0% intentional; 68.2% of the deaths of males were intentional, 29.1% accidental and 2.7% from undetermined intent. Among the intentional deaths, 72.5% of the victims had already suffered violence. As the degree of instruction of the parents increases, intentional deaths decrease. The proportion of reconstituted/fragmented families is higher for fatal accidents. Intentional causes increase as family income decreases and the age of the parents increases. The agglomeration of people in the homes is higher for intentional deaths. Analizing the profiles of families and victims as to the intentionality of the event allows directing local prevention and control policies.

A population-based study of effect of multiple birth on infant mortality in Nigeria

Background

Multi-foetal pregnancies and multiple births including twins and higher order multiples births such as triplets and quadruplets are high-risk pregnancy and birth. These high-risk groups contribute to the higher rate of childhood mortality especially during early period of life.

Methods

We examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors.

Results

Children born multiple births were more than twice as likely to die during infancy as infants born singleton (hazard ratio = 2.19; 95% confidence interval: 1.50, 3.19) holding other factors constant. Maternal education and household asset index were associated with lower risk of infant mortality.

Conclusion

Multiple births are strongly negatively associated with infant survival in Nigeria independent of other risk factors. Mother's education played a protective role against infant death. This evidence suggests that improving maternal education may be key to improving child survival in Nigeria. A well-educated mother has a better chance of satisfying important factors that can improve infant survival: the quality of infant feeding, general care, household sanitation, and adequate use of preventive and curative health services.

Air pollution and pulmonary function in asthmatic children: effects of prenatal and lifetime exposures

BACKGROUND

Prenatal and early life periods represent critical windows for oxidant pollutant-induced lung remodeling. The objective of this study was to examine the association of prenatal and lifetime exposures to air pollutants with pulmonary function in a cohort of children with asthma.

METHODS

Prenatal and lifetime exposure to several air pollutants was reconstructed for 232 children with asthma from the San Joaquin Valley of California, USA. Prenatal and lifetime residences were geocoded. We obtained data on monthly average ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), and particulate matter with a median aerodynamic diameter <10 microm (PM10) concentrations. Metrics were created for key developmental periods. Predictive models were developed for 8 pulmonary function measures. A newly-developed stepwise model selection procedure-the Deletion/Substitution/Addition algorithm-was implemented and results were compared with those obtained using traditional stepwise methods.

RESULTS

Second-trimester exposure to NO2 negatively affected forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1), and first trimester exposure to PM10 negatively affected peak expiratory flow (PEF) rate. Exposure to CO in early years of life also had a negative effect on FEV1/FVC and forced expiratory flow between 25% and 75% of FVC (FEF25-75)/FVC. Second trimester exposure to PM10 and exposure to CO in the first 6 years of life had negative effects on forced expiratory flow at 25% of FVC. Prenatal, but not trimester-specific, exposure to CO was negatively associated with FEF25-75. Effects were limited to subgroups, such as children who were African American, those diagnosed with asthma before the age of 2 years, and those exposed to maternal smoking during pregnancy.

CONCLUSION

Prenatal and early-life exposures to CO, PM10, and NO2 have a negative effect on pulmonary function in subgroups of asthmatic children.

Examining life-course influences on chronic disease: the Ribeirão Preto and São Luís birth cohort studies (Brazil)

More than any other low- and middle-income country, Brazil has the longest research tradition of establishing, maintaining and exploiting birth cohort studies. This research pedigree is highlighted in the present issue of the Brazilian Journal of Medical and Biological Research, which contains a series of twelve papers from the Ribeirão Preto and São Luis birth cohort studies from the Southeast and Northeast of Brazil, respectively. The topics covered in this raft of reports vary and include predictors of perinatal health and maternal risk factors, early life determinants of cardiovascular risk factors in childhood and adolescence, use of health services, and a description of dietary characteristics of young adults, amongst other topics. There is also a guide to the background, objectives, sampling and protocols employed across these studies, which, together with similar pieces published in past issues of the Brazilian Journal, serve as a very useful starting point, particularly for potential collaborators. In the fervent hope that further follow-up of these cohorts will take place--we provide our own justification for cohort maintenance and extension in this issue--future data collection could include: genetic material, atherosclerosis, ascertained, for instance, by intima-media thickness, and IQ testing in children--scores from which are emerging as potentially important predictors of adult health outcomes up to six decades later.