Association of maternal prenatal copper concentration with gestational duration and preterm birth: a multicountry meta-analysis

Background Copper (Cu), an essential trace mineral regulating multiple actions of inflammation and oxidative stress, has been implicated in risk for preterm birth (PTB). Objectives This study aimed to determine the association of maternal Cu concentration during pregnancy with PTB risk and gestational duration in a large multicohort study including diverse populations. Methods Maternal plasma or serum samples of 10,449 singleton live births were obtained from 18 geographically diverse study cohorts. Maternal Cu concentrations were determined using inductively coupled plasma mass spectrometry. The associations of maternal Cu with PTB and gestational duration were analyzed using logistic and linear regressions for each cohort. The estimates were then combined using meta-analysis. Associations between maternal Cu and acute-phase reactants (APRs) and infection status were analyzed in 1239 samples from the Malawi cohort. Results The maternal prenatal Cu concentration in our study samples followed normal distribution with mean of 1.92 μg/mL and standard deviation of 0.43 μg/mL, and Cu concentrations increased with gestational age up to 20 wk. The random-effect meta-analysis across 18 cohorts revealed that 1 μg/mL increase in maternal Cu concentration was associated with higher risk of PTB with odds ratio of 1.30 (95% confidence interval [CI]: 1.08, 1.57) and shorter gestational duration of 1.64 d (95% CI: 0.56, 2.73). In the Malawi cohort, higher maternal Cu concentration, concentrations of multiple APRs, and infections (malaria and HIV) were correlated and associated with greater risk of PTB and shorter gestational duration. Conclusions Our study supports robust negative association between maternal Cu and gestational duration and positive association with risk for PTB. Cu concentration was strongly correlated with APRs and infection status suggesting its potential role in inflammation, a pathway implicated in the mechanisms of PTB. Therefore, maternal Cu could be used as potential marker of integrated inflammatory pathways during pregnancy and risk for PTB

Ayurvedic research for direct public benefit

Currently, interest in Ayurveda research from a public health perspective, is increasing globally due to its ability of improving quality of life and assist individuals to stay healthy. However, there is a dearth of evidence which can substantiate the credibility of this ancient traditional medicine system. Ayurveda today, has to face numerous challenges in collecting evidence and documenting it. The way forward may be understanding these challenges and developing policies which can make Ayurveda research beneficial for the public

Ayurvedic research, wellness and consumer rights

The growing interest in using Ayurvedic medicine as a gentler, safer option to using modern medicine drugs with attendant side effects continues to be thwarted because claims about effectiveness and safety are not backed with evidence and clinical data. The focus of Ayurveda practice and research should be on building bridges to this knowledge for public benefit. The consumer is being denied basic knowledge, access to product information as well as the benefit of a common prescription written by a single treating physician because of three factors – Ayurvedic OTC medicine is generally sold with names and labels which cannot be understood by the consumer despite being easily available without prescription; the treating modern medicine doctor is being prevented from writing the name of a herbal product even when he is individually convinced about its usefulness (in given circumstances) and the absence of biomedical research using objective parameters proving the effectiveness of the drugs. Contemporary Ayurveda needs to be packaged to reach the modern consumer in a way that he gets the benefit of access to treatment options that assist healing within the ambit of the law. These obstacles have to be removed. Patient- based effectiveness studies using retrospective case material as well as research using interdisciplinary approaches are needed for public benefit. This has to be facilitated

Allopathic, AYUSH and informal medical practitioners in rural India – a prescription for change

This paper looks at the treatment seeking behaviour of rural households and presents factors that discourage them from using public health facilities. It also brings out how Allopathic medical graduates as well as institutionally qualified AYUSH doctors predominantly offer services in cities and townships which results in lakhs of village households having to depend on unqualified medical practitioners as the first line of medical treatment; also how this situation will continue unless the approach to providing medical treatment is modified. Continued dependence on unqualified practitioners is fraught with dangers of incorrect diagnosis, irrational drug use, resulting in the spread of multi-drug resistance. The reality that surrounds Allopathic practice by AYUSH doctors has also been described along with the educational underpinnings of accepting this approach.We opine that existing state policies that legitimise Allopathic practice by non-Allopathic practitioners do not help the rural poor to access proper medical treatment for acute conditions. Also, it does not enhance the credibility of the indigenous systems of medicine among which Ayurveda is the dominant system. First, we position our views in the context of the recently introduced National Medical Commission (NMC) Bill 2017 and provisions which call for the assessment of the need for human resources for health and building a road map to achieve the same. Second, we advocate re-inventing the pre-independence system of trained medical auxiliaries enrolled on a new schedule of the respective state medical register, authorised to give immediate medical treatment and making informed referrals for further diagnosis or specialised treatment. Finally, we recommend reinforcing the AYUSH systems to tackle emerging non-communicable diseases which are affecting all population cohorts adversely and, in whose prevention and management, the AYUSH systems are reported to possess special skills and competence. Keywords: Health workforce, Rural India, Unqualified practitioner

Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011.

BACKGROUND: India's 2011 census revealed a growing imbalance between the numbers of girls and boys aged 0-6 years, which we postulate is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. We aimed to establish the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and to quantify the totals of selective abortions of girls with census cohort data. METHODS: We assessed sex ratios by birth order in 0·25 million births in three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective abortion of girls by assessing the birth cohorts of children aged 0-6 years in the 1991, 2001, and 2011 censuses. Our main statistic was the conditional sex ratio of second-order births after a firstborn girl and we used 3-year rolling weighted averages to test for trends, with differences between trends compared by linear regression. FINDINGS: The conditional sex ratio for second-order births when the firstborn was a girl fell from 906 per 1000 boys (99% CI 798-1013) in 1990 to 836 (733-939) in 2005; an annual decline of 0·52% (p for trend=0·002). Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. By contrast, we did not detect any significant declines in the sex ratio for second-order births if the firstborn was a boy, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts with no change or increases. After adjusting for excess mortality rates in girls, our estimates of number of selective abortions of girls rose from 0-2·0 million in the 1980s, to 1·2-4·1 million in the 1990s, and to 3·1-6·0 million in the 2000s. Each 1% decline in child sex ratio at ages 0-6 years implied 1·2-3·6 million more selective abortions of girls. Selective abortions of girls totalled about 4·2-12·1 million from 1980-2010, with a greater rate of increase in the 1990s than in the 2000s. INTERPRETATION: Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective abortion of girls is common. FUNDING: US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, and Li Ka Shing Knowledge Institute

Prevalence of specific learning disorders in school children in a South Indian city

Background: Specific learning disorders (SLDs) are an important cause of academic problems in school children mandating assessment and remediation. Aim: To document the psychosocial profile and prevalence of SLDs in school children. Materials and Methods: A total of 981 children studying in 3rd to 5th standard were screened for the presence of SLDs in a stepwise approach after taking permission from school authorities and consent from parents. Raven's Progressive Matrices, Malins Intelligence Scale, and NIMHANS SLD Index were used for assessment. Statistical analysis was performed using Epi info software. Results: The prevalence of SLDs was found to be 6.1% (n = 60). Dyslexia was the most common SLD (n = 38; 63%) followed by combined type (n = 28; 46%). A significant association was found between consanguinity (P = 0.02) and delayed milestones (P = 0.02). Conclusion: There is a need for creating the awareness among parents and teachers regarding SLDs and to screen children for the early identification and remediation