Maternal BMI and nutritional status in early pregnancy and its impact on neonatal outcomes at birth in Bangladesh

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background To assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6–14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight. Methods The investigation was conducted from April 2011 to June 2012 in Dhaka, Bangladesh. A total of 498 primigravida pregnant women participated in the study; women with known diabetes or previous gestational diabetes (GDM) were excluded. Maternal demographic details, pregnancy history and anthropometric measurements were obtained from the mother at the recruitment (6–14 weeks), 2nd visit between 24 and 28 week of gestation and 3rd visit at delivery. Cord venous blood samples of newborns (n = 138) were collected immediately after delivery for blood glucose, insulin, lipid profile, leptin and micronutrients including serum folate, ferritin, homocysteine, vitamin D, and vitamin B12. Results The prevalence at 6–14 weeks of pregnancy of anemia (Hb,  15 μmol/l), folate deficiency (< 3 ng/ml) and iron deficiency (ferritin < 13 ng/ml) were 19.5, 46.4, 15.1, 1.2, 0.4, and 12.7% respectively. GDM was found in 18.4% women. The prevalence of GDM was higher in overweight women (28.1%) than underweight (16.7%) and normal weight women (16.0%: p <  0.05). The incidence of low birth weight (LBW) and preterm delivery were 11.6 and 5.8% respectively and was not related to maternal BMI at 6–14 weeks of pregnancy. Maternal height was positively (p = 0.02), and homocysteine was negatively associated with neonatal birth weight (p = 0.02). In addition, the newborn’s cord serum folate was positively (p = 0.03) and cord triglyceride was negatively (p = 0.03) associated with neonatal birth weight. Conclusion Multiple maternal micronutrient deficiencies were present in early pregnancy. Maternal BMI in early pregnancy was not related to preterm deliveries or LBW. LBW was associated with lower folate, elevated cord triglyceride concentrations of the neonates and mother’s height and increase in maternal homocysteine levels. The data has important implications for pregnancy care in Bangladesh and other similar communities.Financial support from European Union (FP7 EU grant: 83599025)

Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial

Author summary Why was this study done? Hip and knee osteoarthritis is a common chronic joint disease in the adult population causing significant pain and disability. Non-surgical treatment modalities including patient osteoarthritis education, exercise therapy, and weight management represent core treatments recommended in professional guidelines. However, they are currently underutilised in people with hip and knee osteoarthritis. It is not established to what extent a structured osteoarthritis care model can change this and improve the quality of care. What did the researchers do and find? A cluster-randomised trial was conducted to compare a structured osteoarthritis care model with usual care with respect to appropriate care delivery in people with hip and knee osteoarthritis. Forty general practitioners and 37 physiotherapists working in primary care attended workshops to get an update on recommendations for osteoarthritis care and were trained in the core elements of the structured care model: osteoarthritis education in groups, an individually tailored 8- to 12-week exercise programme, and a dietary intervention, if needed. Of the 393 patient participants, 284 were allocated to the intervention group and 109 to the usual care group. At 6 months, patient-reported quality of care and satisfaction with care were greater, more patients were referred to physiotherapy and fewer to orthopaedic surgeons, and more patients fulfilled physical activity criteria in the intervention group as compared to the usual care group. What do these findings mean? A structured osteoarthritis care model provided by trained primary care general practitioners and physiotherapists resulted in the provision of osteoarthritis care that was more in line with current care recommendations and in higher patient-reported quality of care and satisfaction as compared to usual care. A structured and well-planned approach, in line with evidence-based treatment recommendations for hip and knee osteoarthritis and executed in primary care, has the potential to improve patients’ health and reduce disability. In doing so, it may also reduce the risk of sick leave and may thereby reduce the direct and indirect costs of osteoarthritis for the individual and the society. Although a stepped-wedge cluster-randomised controlled trial design is appropriate to conduct an effectiveness study in a clinical practice setting, strategies to prevent selection bias and differences in recruitment rates in the control and intervention periods are needed

Use of parametric and non-parametric survival analysis techniques to evaluate the effectiveness of two acaricides in controlling tsetse flies. (Diptera Glossinidae).

This paper presents parametric and non-parametric survival analysis procedures that can be used to compare acaricides. The effectiveness of Delta Tick Pour On and Delta Tick Spray in knocking down tsetse flies were determined. The two formulations were supplied by Chemplex. The comparison was based on data collected from trials carried out in Zimbabwe at Rukomichi Research Station in 2003. Rukomichi Research Station is owned by the Department of Veterinary Services and is mainly used for conducting research on tsetse flies. The Kaplan Meier estimate of survivor and hazard function was used as the non-parametric procedure for comparing survival times of tsetse exposed to Delta Tick Spray and Delta Tick Pour On. In addition the log rank statistic was also used to explore the differences between the two formulations. The parametric procedure assumed that the survival times follow a lognormal distribution after checking the suitability of the distribution and estimating the hazard, survivor function and quartiles assuming the distribution. A proportional hazard model was also fitted to compare the two formulations. The non-parametric procedure revealed that the median survival times of tsetse exposed to Delta Tick Pour On was 10 minutes compared to 12 minutes for those exposed to Delta Tick Spray. The parametric procedure showed that the median survival time of tsetse exposed to Delta Tick Pour On was 10.59 minutes compared to 13.70 for those exposed to Delta Tick Spray. The proportional hazards model indicated that the hazard of being knocked down is 1.335 more for tsetse exposed to Delta Tick Pour On than those on Delta Tick Spray (p < 0.001). Keywords: Acaricides, parametric, non-parametric survival analysis procedures, tsetse flie

Associations between gestational diabetes mellitus and elevated HbA1c early postpartum in a multi-ethnic population

Aims To investigate the prevalence of elevated HbA1c 14 weeks postpartum in different ethnic groups and in women with and without gestational diabetes mellitus (GDM) in the index pregnancy and to explore demographic and biological factors from early pregnancy associated with elevated HbA1c (HbA1c ≥5.7% (≥39 mmol/mol)) postpartum. Methods From a cohort study in Oslo, Norway, we included 570 pregnant women, examined in gestational week 15, 28, and 14 weeks postpartum. The association between elevated HbA1c and demographic and biological factors were assessed by logistic regression analyses. Results The prevalence of elevated HbA1c postpartum was 23% in the total population, 15% among Western Europeans and 28% among women with ethnic minority background (p < 0.01). In ethnic minorities elevated HbA1c was found in 39% of women with recent GDM diagnosed by the World Health Organization 2013 criteria and in 21% of women without GDM (p < 0.01), compared to 22% and 13% in Western Europeans (p = 0.11). We found independent associations between elevated HbA1c and ethnic minority background (OR 2.0, 95% CI 1.27, 3.18), and GDM (OR 2.04, 95% CI 1.35, 3.10) (p < 0.01). Conclusions The prevalence of elevated HbA1c postpartum was 23%, and significantly higher among women with ethnic minority background irrespective of GDM

Ethnic differences in body mass index trajectories from 18 years to postpartum in a population-based cohort of pregnant women in Norway

Objectives: To explore ethnic differences in changes in body mass index (BMI) from the age of 18 years to 3 months postpartum. Design: A population-based cohort study. Setting: Child Health Clinics in Oslo, Norway. Participants: Participants were 811 pregnant women (mean age 30 years). Ethnicity was categorised into six groups. Primary outcome measures: The outcome variable was BMI (kg/m2) measured at the age of 18 and 25 years, at prepregnancy and at 3 months postpartum. Body weight at 18 years, 25 years and prepregnancy were self-reported in early pregnancy, while body height and weight at 3 months postpartum were measured. The main statistical method was generalised estimating equations, adjusted for age. The analyses were stratified by parity due to ethnicity×time×parity interaction (p<0.001). Results: Primiparous South Asian women had a 1.45 (95% CI 0.39 to 2.52) kg/m² higher and Middle Eastern women had 1.43 (0.16 to 2.70) kg/m2 higher mean BMI increase from 18 years to postpartum than Western European women. Among multiparous women, the mean BMI increased 1.99 (1.02 to 2.95) kg/m2 more in South Asian women, 1.48 (0.31 to 2.64) kg/m2 more in Middle Eastern women and 2.49 (0.55 to 4.42) kg/m2 more in African women than in Western European women from 18 years to prepregnancy. From 18 years to postpartum, the mean increase was 4.40 (2.38 to 6.42) kg/m2 higher in African women and 1.94 to 2.78 kg/m2 higher in the other groups than in Western European women. Conclusions: Multiparous women of ethnic minority origin seem substantially more prone to long-term weight gain than multiparous Western European women in Norway

One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status

Abstract Background Increased psychological pressure on oral healthcare professionals (OHP) due to COVID-19 has been shown, yet little is known about the long-term psychological impacts. We aimed to study the psychological impact of COVID-19 and associated factors including perceived risk and preparedness and vaccination status among OHP in the first year after the lockdown period in Norway. Methods A structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired experiences and perceptions during the second year following the outbreak in Norway. The questionnaire comprised a COVID-19 fear scale and questions about risk perception, preparedness and vaccination status. Exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used to assess psychological impact, perception of risk and preparedness according to vaccination status of the respondents. Results The majority of the 708 respondents were female (92.8%), had ten or more years of work experience (67.1%), and worked in public dental clinics (95.9%). Fears and concerns related to COVID-19 were common, 72.6% feared getting infected and 85.4% feared infecting others. Of the 642 respondents who agreed that their workplaces handled the situation well, 55.6% were fully vaccinated. Three factors were retrieved from EFA: Insecurity, Instability and Infection. SEM showed that females were more concerned with Infection, and respondents with long clinical experience were less likely to express fear about Instability. Fully vaccinated individuals felt more insecure about becoming infected, and those agreeing that their workplaces handled the current situation well were concerned with Insecurity. Conclusions Despite widespread perception of adequate preparedness and high vaccine coverage, a considerable psychological impact and high levels of fear of COVID-19 were observed among the majority of OHP. Fully vaccinated individuals had a larger psychological burden than not fully vaccinated and those with unknown vaccination status. These findings can inform means and interventions to reduce negative impacts of fear in populations with a high psychological burden

Psychological impact of the COVID-19 pandemic on dental health personnel in Norway

Background The SARS-CoV-2 pandemic put a pressure on all healthcare professionals and has affected the delivery of health care services globally. There is a need to understand the impact on different health care professionals in different countries. The aim of the present study was to explore the psychological impact of the pandemic among dental staff in Norway in relation to background characteristics, work situation and preparedness of the service. Methods A structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired information about the lockdown period in Norway (13 March-17 April 2020). Distributions of background characteristics, perceptions of preparedness and psychological impact were calculated. Exploratory factor analysis was performed, and Structural Equation Models (SEMs) were used to compare psychological impact between dental professionals treating patients versus not during lockdown. Results Among the 1237 respondents, 58.8% worked clinically with patients. The majority were concerned of becoming infected (71.9%), of infecting others (85.4%) and/or of their family becoming infected (76.9%). Respondents who treated patients felt significantly more insecure about whether having become infected or not. The minority felt discriminated (6.7%), worried about death (11.7%), felt that life was threatening (9.8%) or felt loss of control of their lives (8.9%). More than 80% agreed that their workplace handled the situation well. Four factors were retrieved from the factor analysis. SEMs showed that gender and work experience had a significant effect on the factors Instability, Infection and Concerns. Respondents with work experience ≥10 years were less likely to express fear about Instability and Infection. Personnel reporting that their workplace had adequate equipment were also less concerned, however having adequate equipment did not reduce the factor Loss of control. Conclusion The present study showed a considerable psychological impact of the COVID-19 pandemic on dental personnel in Norway regardless of working clinically with patients or not. However, working with patients increased the insecurity about own infection status and of infecting people close to them. A safe working environment and adequate infection control measures are associated with less fear of infection and feeling of instability

Lipid and lipoprotein concentrations during pregnancy and associations with ethnicity

Background To describe ethnic differences in concentrations of lipids and lipoproteins, and their changes, during pregnancy to postpartum. Methods This was a population-based cohort study conducted in primary antenatal care in Norway. The participants (n = 806) were healthy, pregnant women, 59% were ethnic minorities. Outcomes were triglycerides, total cholesterol, HDL- and LDL-cholesterol, analysed from fasting blood samples drawn at gestational age (weeks) 15, 28 and 14 weeks postpartum. We performed linear regression models and linear mixed models to explore the total effect of ethnicity on the outcomes, adjusting for gestational age /week postpartum, maternal age and education. The analyses are corrected for multiple testing using the Bonferroni correction. Results At gestational age 15, triglyceride concentrations were lower in women of African origin (1.03 mmol/mol (95% CI: 0.90, 1.16)) and higher in women of South Asian (primarily Pakistan and Sri Lanka) origin (1.42 mmol/mol (1.35, 1.49)) and East Asian (primarily Vietnam, Philippines and Thailand) origin (1.58 mmol/mol (1.43, 1.73)) compared with Western Europeans (1.26 mmol/mol (1.20, 1.32)). Women of Asian and African origin had a smaller increase in triglycerides, LDL- and total cholesterol from gestational age 15 to 28. At gestational age 28, LDL-cholesterol levels were lowest among East Asians (3.03 mmol/mol (2.72, 3.34)) compared with Western Europeans (3.62 mmol/mol (3.50, 3.74)). Triglycerides and HDL-cholesterol were lower postpartum than at gestational age 15 in all groups, but the concentration of LDL-cholesterol was higher, except in Africans. South and East Asian women had lower HDL-cholesterol and higher triglycerides postpartum, while African women had lower triglycerides than Western Europeans. Conclusion We found significant differences in the concentrations of lipids and lipoproteins and their changes during pregnancy and the early postpartum period related to ethnic origin