Experiences and outcomes of maternal Ramadan fasting during pregnancy: results from a sub-cohort of the Born in Bradford birth cohort study

Background: Observing the fast during the holy month of Ramadan is one of the five pillars of Islam. Although pregnant women and those with pre-existing illness are exempted from fasting many still choose to fast during this time. The fasting behaviours of pregnant Muslim women resident in Western countries remain largely unexplored and relationships between fasting behaviour and offspring health outcomes remain contentious. This study was undertaken to assess the prevalence, characteristics of fasting behaviours and offspring health outcomes in Asian and Asian British Muslim women within a UK birth cohort. Methods: Prospective cohort study conducted at the Bradford Royal Infirmary UK from October to December 2010 comprising 310 pregnant Muslim women of Asian or Asian British ethnicity that had a live singleton birth at the Bradford Royal Infirmary. The main outcome of the study was the decision to fast or not during Ramadan. Secondary outcomes were preterm births and mean birthweight. Logistic regression analyses were used to investigate the relationship between covariables of interest and women's decision to fast or not fast. Logistic regression was also used to investigate the relationship between covariables and preterm birth as well as low birth weight. Results: Mutually adjusted analysis showed that the odds of any fasting were higher for women with an obese BMI at booking compared to women with a normal BMI, (OR 2.78 (95% C.I. 1.29-5.97)), for multiparous compared to nulliparous women(OR 3.69 (95% C.I. 1.38-9.86)), and for Bangladeshi origin women compared to Pakistani origin women (OR 3.77 (95% C.I. 1.04-13.65)). Odds of fasting were lower in women with higher levels of education (OR 0.40 (95% C.I. 0.18-0.91)) and with increasing maternal age (OR 0.87 (95% C.I. 0.80-0.94). No associations were observed between fasting and health outcomes in the offspring. Conclusions: Pregnant Muslim women residing in the UK who fasted during Ramadan differed by social, demographic and lifestyle characteristics compared to their non-fasting peers. Fasting was not found to be associated with adverse birth outcomes in this sample although these results require confirmation using reported fasting data in a larger sample before the safety of fasting during pregnancy can be established

Introduction and evaluation of a 'pre-ART care' service in Swaziland: an operational research study

Objective: To implement and evaluate a formal pre-antiretroviral therapy (ART) care service at a district hospital in Swaziland. Design: Operational research. Setting: District hospital in Southern Africa. Participants: 1171 patients with a previous diagnosis of HIV. A baseline patient group consisted of the first 200 patients using the service. Two follow-up groups were defined: group 1 was all patients recruited from April to June 2009 and group 2 was 200 patients recruited in February 2010. Intervention: Introduction of pre-ART care-a package of interventions, including counselling; regular review; clinical staging; timely initiation of ART; social and psychological support; and prevention and management of opportunistic infections, such as tuberculosis. Primary and secondary outcome measures: Proportion of patients assessed for ART eligibility, proportion of eligible patients who were started on ART and proportion receiving defined evidence-based interventions (including prophylactic co-trimoxazole and tuberculosis screening). Results: Following the implementation of the pre-ART service, the proportion of patients receiving defined interventions increased; the proportion of patient being assessed for ART eligibility significantly increased (baseline: 59%, group 1: 64%, group 2: 76%; p=0.001); the proportion of ART-eligible patients starting treatment increased (baseline: 53%, group 1: 81%, group: 2, 81%; p<0.001) and the median time between patients being declared eligible for ART and initiation of treatment significantly decreased (baseline: 61 days, group 1: 39 days, group 2: 14 days; p<0.001). Conclusions: This intervention was part of a shift in the model of care from a fragmented acute care model to a more comprehensive service. The introduction of structured pre-ART was associated with significant improvements in the assessment, management and timeliness of initiation of treatment for patients with HIV

Maternal health inequalities and GP provision: investigating variation in consultation rates for women in the Born in Bradford cohort

Background The ‘Five Year Forward View’ (NHS England) calls for a radical upgrade in public health provision. Inequalities in maternal health may perpetuate general patterns of health inequalities across generations; therefore equitable access to GP provision during maternity is important. This paper explores variation in GP consultation rates for disadvantaged mothers. Method Data from the Born in Bradford cohort (around 12,000 women), combined with GP records and GP practice variables, were modelled to predict GP consultation rates, before and after adjusting for individual health and GP provision. Results Observed GP consultation rates are higher for women in materially deprived neighbourhoods and Pakistani women. However these groups were found to consult less often after controlling for individual health. This difference, around one appointment per year, is ‘explained’ by the nature of GP provision. Women in practices with a low GP to patient ratio had around 9 fewer consultations over the six year period compared to women in practices with the highest ratio. Conclusions Equitable access to GP services, particularly for women during the maternal period, is essential for tackling deep-rooted health inequalities. Future GP funding should take account of neighbourhood material deprivation to focus resources on areas of the greatest need

Maternal psychological distress in primary care and association with child behavioural outcomes at age three

Observational studies indicate children whose mothers have poor mental health are at increased risk of socio-emotional behavioural difficulties, but it is unknown whether these outcomes vary by the mothers’ mental health recognition and treatment status. To examine this question, we analysed linked longitudinal primary care and research data from 1078 women enrolled in the Born in Bradford cohort. A latent class analysis of treatment status and self-reported distress broadly categorised women as (a) not having a common mental disorder (CMD) that persisted through pregnancy and the first 2 years after delivery (N = 756, 70.1 %), (b) treated for CMD (N = 67, 6.2 %), or (c) untreated (N = 255, 23.7 %). Compared to children of mothers without CMD, 3-year-old children with mothers classified as having untreated CMD had higher standardised factor scores on the Strengths and Difficulties Questionnaire (d = 0.32), as did children with mothers classified as having treated CMD (d = 0.27). Results were only slightly attenuated in adjusted analyses. Children of mothers with CMD may be at risk for socio-emotional and behavioural difficulties. The development of effective treatments for CMD needs to be balanced by greater attempts to identify and treat women

Physical activity, sedentary time, and fatness in a biethnic sample of young children

Purpose: This study aimed to investigate associations of objectively measured physical activity (PA) and sedentary time with adiposity in a predominantly biethnic (South Asian and White British) sample of young children. Methods: The sample included 333 children age 11 months to 5 yr who provided 526 cross-sectional observations for PA and body composition. Total PA volume (vector magnitude counts per minute), daily time at multiple intensity levels (the cumulative time in activity 9500, 91000, 91500, I, 96000 counts per minute), and time spent sedentary (G820 counts per minute), in light PA (820–3907 counts per minute) and in moderate-to-vigorous PA (Q3908 counts per minute) were estimated with triaxial accelerometry. Indicators of adiposity included body mass index, waist circumference, and the sum of subscapular and triceps skinfold thicknesses. Statistical analyses were performed using multilevel regression and isotemporal substitution models adjusted for confounders. Effect modification by ethnicity was examined. Results: There was no evidence for effect modification by ethnicity (P interaction Q 0.13). In the whole sample, the accumulated time spent above 3500 counts per minute (i.e., high light-intensity PA) was inversely associated with the sum of skinfolds (A = j0.60 mm, 95% confidence interval [CI] = j1.19 to j0.021, per 20 minIdj1), and the magnitude of association increased dose dependently with PA intensity (peaking for time spent 96000 counts per minute = j1.57 mm, 95% CI = j3.01 to j0.12, per 20 minIdj1). The substitution of 20 minIdj1 of sedentary time with moderate-to-vigorous PA was associated with a lower sum of skinfolds (j0.77 mm, 95% CI = j1.46 to j0.084). Conclusions: High light-intensity PA appears to be beneficial for body composition in young South Asian and White British children, but higher-intensity PA is more advantageous

Ethnic differences in the clustering and outcomes of health behaviours during pregnancy: results from the Born in Bradford cohort

OBJECTIVE. Pregnancy is a time of optimal motivation for many women to make positive behavioural changes. We aim to describe pregnant women with similar patterns of self-reported health behaviours and examine associations with birth outcomes. METHODS. We examined the clustering of multiple health behaviours during pregnancy in the Born in Bradford cohort, including smoking physical inactivity, vitamin d supplementation, and exposure to second hand smoke. Latent class analysis was used to identify groups of individuals with similar patterns of health behaviours separately for White British (WB) and Pakistani mothers. Multinomial regression was then used to examine the association between group membership and birth outcomes, which included preterm birth and mean birth weight. RESULTS. For WB mothers, offspring of those in the ‘Unhealthiest’ group had lower mean birth weight than those in the ‘Mostly healthy but inactive’ class, although no association was observed for preterm birth. For Pakistani mothers, group membership was not associated with birth weight differences, although the odds of preterm birth was higher in ‘Inactive smokers’ compared to the ‘Mostly healthy but inactive’ group. CONCLUSION. The use of latent class methods provides important information about the clustering of health behaviours which can be used to target population segments requiring behaviour change interventions considering multiple risk factors. Given the dominant negative association of smoking with the birth outcomes investigated, latent class groupings of other health behaviours may not confer additional risk information for these outcomes

The Turing Bombe <i>Victory</i> and the first naval Enigma decrypts

<p><i>Victory</i> was the name of the first prototype Bombe that was developed for breaking the German Enigma messages of World War II. It lacked the diagonal board and simultaneous scanning that was provided for all the later models, but these disadvantages were overcome by the ingenious use of a column menu (a special Bombe menu where the Enigma fast rotors are all in the same position) to break six days of naval traffic, 22–27 April 1940, following the pinch of material from an armed trawler <i>Schiff 26</i> (<i>Polares</i>). These were the first naval decrypts of the War, and their solution took several months to complete. No further naval breaks occurred until November. This article examines the decryption process in some detail in order to explain the difficulties, highlight the role of <i>Victory</i> in this process, and provide detailed workings of the processes. It also sheds some light on the early development of the British Bombe.</p

Convection at the indoor side of complex fenestration systems: the ASHWAT model revisited

<p>This paper examines the three-temperature problem of convection at the indoor side of a complex fenestration system (CFS) based on recent theoretical developments, namely the extended Newton formulation and the dQdT technique. CFD solutions were obtained for natural convection at the indoor side of various CFS configurations. The dQdT technique was then implemented numerically to obtain the paired heat transfer coefficients of each configuration. The results were used to assess the approximate relations used in the ASHRAE Window ATachment (ASHWAT) tool. The comparison shows that while there is remarkable agreement between the ASHWAT estimates and dQdT results for roller blinds, discrepancies exist between results for venetian blinds. Furthermore, although use of a delta resistor network to model convection at the indoor side is valid and relatively accurate for roller blinds, the application of this model to CFSs with venetian blinds requires additional levels of approximation. Nevertheless, the heat transfer rates calculated based on the approximate resistor-network model are in close agreement with the CFD results.</p

Supplementary document for New strategies for phase matching control in multidimensional Floquet state spectroscopy - 6810424.pdf

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