Weight, height, and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross‐sectional study

We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia. A cross‐sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight, and midupper arm circumference (MUAC). Hb levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, and height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% confidence interval, CI, [0.08, 0.15], P < .001). Each kilogram of increase in the body weight showed an increase in Hb levels (0.02 g dl, 95% CI [0.01, 0.03], P = .001). With an each centimetre of increase in height, Hb increased by 0.01 g dl (95% CI [0.00, 0.02], P = .022). There was a consistent association between three measures of somatic growth and anaemia in the study population. It is likely that life‐course exposures from conception onwards contribute to this, and the public health implications are that preventing anaemia is a challenge that requires a multifaceted interventional approach. Understanding the importance of the timing of these life exposures will help design interventions that can achieve optimal results

Association of socioeconomic status with sex ratio at live birth in individuals living in the slums of Sholapur city, India

Background: The existence of female feticide in India is well known. However, limited data are available on the association of socioeconomic status (SES) on sex ratio at live birth in disadvantaged populations, despite the fact that 33% of the population of India live on less than $1.25 per day. Objective: To study the association of SES with sex ratio at live birth in individuals living in the slums of Sholapur city, India. Materials and Methods: We used the data collected as a part of a social work intervention in the slums of Sholapur city, Maharashtra, from January 2007 to August 2011. Two measures of SES were used, location of birth (government hospital compared to private hospital) and eligibility for means-tested financial support after delivery. Results: Data were available for 1391 infants. The infants born in government hospitals were more likely to be male compared to those born in private hospitals (sex ratio of 1.45 compared to 1.14, respectively, p = 0.03). Similarly, infants whose parents were eligible for post-delivery financial support had a trend to a higher sex ratio (1.47 compared to 1.18, p = 0.057). Maternal age was independently and inversely associated with sex ratio at live birth with a linear relation (OR per year increase in maternal age 0.96, 95% CI 0.93–1.00, p = 0.03). Conclusion: In this particular population, two measures of less affluent SES were associated with higher sex ratio at live birth. However, care should be taken while generalizing these observations to other disadvantaged groups living in India, but this represents an area of research where more epidemiological work is required, as these differences perpetuated over generations may have substantial demographic consequences

Concerns about covert HIV testing are associated with delayed presentation of suspected malaria in Ethiopian children: a cross-sectional study

BACKGROUND Early diagnosis is important in preventing mortality from malaria. The hypothesis that guardians' fear of covert human immunodeficiency virus (HIV) testing delays presentation of children with suspected malaria was tested. METHODS The study design is a cross-sectional survey. The study population consisted of guardians of children with suspected malaria who presented to health centres in Oromia Region, Ethiopia. Data were collected on attitudes to HIV testing and the duration of children's symptoms using interview administered questionnaires. RESULTS Some 830 individuals provided data representing a response rate of 99% of eligible participants. Of these, 423 (51%) guardians perceived that HIV testing was routinely done on blood donated for malaria diagnosis, and 353 (43%) were aware of community members who delayed seeking medical advice because of these concerns. Children whose guardians suspected that blood was covertly tested for HIV had longer median delay to presentation for evaluation at health centres compared to those children whose guardians did not hold this belief (three days compared to two days, p < 0.001). Children whose guardians were concerned about covert HIV testing were at a higher odds of a prolonged delay before being seen at a health centre (odds ratio 1.73, 95% confidence intervals: 1.10 to 270 for a delay of ≥ 3 days compared to those seen in ≤ 2 days). CONCLUSION Children whose guardians believed that covert testing for HIV was routine clinical practice presented later for investigation of suspected malaria. This may account for up to 14% of the delay in presentation and represents a reversible risk factor for suboptimal management of malaria

Weight, height and midupper arm circumference are associated with haemoglobin levels in adolescent girls living in rural India: A cross-sectional study

Objective:We aimed to explore the association of physical parameters with haemoglobin (Hb) levels to test the hypothesis that impaired physical development is associated with anaemia.Methods:A cross-sectional survey study recruited adolescent girls (13 to 17 years) living in rural areas of Maharashtra state of India. Data were collected on physical parameters include height, weight and mid upper arm circumference (MUAC). Haemoglobin (Hb) levels were measured using Sahli's haemometer. Linear regression was conducted to test the hypothesis. Results:Data were collected from 1,010 girls on physical parameter and Hb levels. The majority of the adolescent girls were diagnosed with anaemia (87%). The regression analysis adjusted for age gave a significant association of Hb levels with all three variables (MUAC, weight, height). Hb increased by 0.11 g/dl with an each centimetre of increase in MUAC (95% CI: 0.08 to 0.15,

Rate of improvement of CF life expectancy exceeds that of general population: observational death registration study

Background: It is unclear why cystic fibrosis (CF) survival has improved. We wished to quantify increases in CF median age of death in the context of general population survival improvement. Method: Death registration data analysis (US, England & Wales (E&W)—1972–2009). Results: CF median age of death is higher in US than E&W and greater for males, opposite to that of death from all causes. CF median age of death has increased by 0.543 life years per year (E&W, US combined (95% confidence interval 0.506, 0.582)). The difference in median age at death between those dying from all causes and CF decreased in both territories. CF median age of death for males is greater than for females in both territories. This gap has not narrowed. Conclusion: The median age of death of people with CF is improving more rapidly than that of the general population in US and E&W

In-hospital mortality following surgical lung biopsy for interstitial lung disease in the USA: 2000-2011

Rationale: Surgical lung biopsy can help to determine a specific diagnosis in interstitial lung disease, but has associated risks. Most currently available mortality data are derived from case series and may not be generalizable to broader populations. Objectives: We aimed to assess in-hospital mortality following surgical lung biopsy for interstitial lung disease in a national secondary care dataset from the United States. Methods: Data were obtained from the 2000-2011 Nationwide Inpatient Sample. Cases were identified using International Classification of Diseases (ICD-9-CM) codes for interstitial lung disease and surgical lung biopsies. Lung resections and cases of lung cancer were excluded. Weighted data were used to estimate numbers of biopsies nationwide and in-hospital mortality, and multivariable logistic regression was used to adjust for sex, age, geographic region, co-morbidity, type of operation and provisional diagnosis. Measurements and Main Results: We estimated there to be around 12,000 surgical lung biopsies performed annually for interstitial lung disease in the United States, two-thirds of which were performed electively. In-hospital mortality was 1.7% for elective procedures, but significantly higher for non-elective procedures (16.0%). Male sex, increasing age, increasing co-morbidity, open surgery and a provisional diagnosis of idiopathic pulmonary fibrosis or connective tissue disease related interstitial lung disease were risk factors for increased mortality. Conclusions: In-hospital mortality following elective surgical lung biopsy for interstitial lung disease is just under 2%, but significantly higher for non-elective procedures. Identified risk factors for death should be taken into account when counselling patients on whether to pursue a histological diagnosis

Global incidence and mortality of idiopathic pulmonary fibrosis: a systematic review

Introduction: As idiopathic pulmonary fibrosis emerges as an important public health problem, there is a need to coordinate data on incidence and mortality globally. This study aims to systematically assess all available studies to investigate the global burden of disease. Methods: Medline and Embase databases were searched systematically for all population-based studies of incidence or mortality of idiopathic pulmonary fibrosis. Clinical case series and prevalence studies were excluded. The search was supplemented using Google search engine, hand-searching of references and conference abstracts. Data were extracted independently by two authors using a pre-specified proforma, with assessment of methodological quality. Results: 34 studies were identified providing data from 21 countries from 1968-2012. 28 studies reported incidence data, and eight reported mortality data. In studies from year 2000 onwards, we estimated a conservative incidence range of 3-9 cases per 100,000 per year for Europe and North America. Incidence was lower in East Asia and South America. The majority of studies showed an increase in incidence over time. Conclusions: The incidence of idiopathic pulmonary fibrosis is increasing worldwide, and rates are coming together across countries. Current data suggest incidence is similar to that of conditions such as stomach, liver, testicular and cervical cancers

Complications and mortality in hereditary hemorrhagic telangiectasia: a population-based study

OBJECTIVES: Studies report that the risks of significant neurologic complications (including stroke, cerebral abscess, and migraine) and hemorrhagic sequelae are high in patients with hereditary hemorrhagic telangiectasia (HHT), and that life expectancy in this cohort is reduced. However, most published cohorts derive from specialist centers, which may be susceptible to bias. METHODS: We used a population-based approach to estimate the risks of developing neurologic and hemorrhagic complications of HHT, the association of a diagnosis of HHT with common cardiovascular and malignant comorbidities, and also long-term survival of those with the disease. RESULTS: From a UK primary care database of 3.5 million patients (The Health Improvement Network), we identified 675 cases with a diagnosis of HHT and compared them with 6,696 controls matched by age, sex, and primary care practice. Risks of stroke (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.6), cerebral abscess (OR 30.0, CI 3.1-288), and migraine (OR 1.7, CI 1.3-2.2) were elevated over controls. Bleeding complications including epistaxis (OR 11.6, CI 9.1-14.7) and gastrointestinal hemorrhage (OR 6.1, CI 2.8-13.4) were more common in cases with HHT. Survival of cases with HHT was poorer than controls with a hazard ratio for death of 2.0 (CI 1.6-2.6) and a median age at death 3 years younger. CONCLUSIONS: Patients with HHT are at substantially increased risk of serious neurologic and hemorrhagic complications of the disease. Because a diagnosis of HHT is associated with a significantly poorer survival compared with those who have no disease, evaluation of new strategies to improve clinical management is required

Association between socioeconomic status, sex, and age at death from cystic fibrosis in England and Wales (1959 to 2008): cross sectional study

Objective To determine the trend in the association between socioeconomic status and sex and median age at death from cystic fibrosis in England and Wales, over the past 50 years

Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study

Objective: The aim of this prospective study was to estimate the prevalence and risk factors for maternal anaemia and low birth weight in pregnant women living in Maharashtra state, India. Study design: Prospective study Methods: Women between 3 to 5 months of pregnancy were recruited from 34 villages based in Maharashtra state. Baseline data collection, anthropometric measurements and blood investigations were performed. Participants were followed-up to record birth weight. Results: In total, 303 women were eligible, and 287 (95%) provided data. 77% were anaemic defined as haemoglobin less than 11.0 g/dL at the time of recruitment, with a mean corpuscular volume (MCV) of 80.5 fl/cell, (standard deviation: 7.22, range: 53.4 to 93.8). Increased risk of anaemia was seen in women with consanguineous marriages (odds ratio (OR): 2.41, 95% Confidence Interval (CI): 1.16 to 5.01, p=0.01) after adjustment for potential confounding factors. Post-delivery data from full-term singleton live births demonstrated a 7% prevalence of low birth weight. Consanguineous marriage was a major risk for low birth weight (OR: 4.10, 95% CI: 1.25 to 13.41, p=0.02). The presence of maternal anaemia during 3 to 5 months of pregnancy was associated with lower risk of low birth weight (unadjusted OR: 0.34, 95% CI: 0.13 to 0.92, p= 0.03). Conclusion: About 30% of our study participants were in a consanguineous marriage, which was identified as a potentially avoidable risk factor for both anaemia and low birth weight