Chlamydia trachomatis and the risk of spontaneous preterm birth, babies who are born small for gestational age, and stillbirth: A population-based cohort study

Background: Chlamydia trachomatis is one of the most commonly diagnosed sexually transmitted infections worldwide, but reports in the medical literature of an association between genital chlamydia infection and adverse obstetric outcomes are inconsistent. Methods: The Western Australia Data Linkage Branch created a cohort of women of reproductive age by linking records of birth registrations with the electoral roll for women in Western Australia who were born from 1974 to 1995. The cohort was then linked to both chlamydia testing records and the state perinatal registry for data on preterm births and other adverse obstetric outcomes. We determined associations between chlamydia testing, test positivity, and adverse obstetric outcomes using multivariate logistic regression analyses. Findings: From 2001 to 2012, 101558 women aged 15 to 38 years had a singleton birth. Of these women, 3921 (3·9%) had a spontaneous preterm birth, 9762 (9·6% of 101371 women with available data) had a baby who was small for gestational age, and 682 (0·7%) had a stillbirth. During their pregnancy, 21267 (20·9%) of these women had at least one chlamydia test record, and 1365 (6·4%) of those tested were positive. Before pregnancy, 19157 (18·9%) of these women were tested for chlamydia, of whom 1595 (8·3%) tested positive for chlamydia. Among all women with a test record, after adjusting for age, ethnicity, maternal smoking, and history of other infections, we found no significant association between a positive test for chlamydia and spontaneous preterm birth (adjusted odds ratio 1·08 [95% CI 0·91–1·28]; p=0·37), a baby who was small for gestational age (0·95 [0·85–1·07]; p=0·39), or stillbirth (0·93 [0·61–1·42]; p=0·74). Interpretation: A genital chlamydia infection that is diagnosed and, presumably, treated either during or before pregnancy does not substantially increase a woman’s risk of having a spontaneous preterm birth, having a baby who is small for gestational age, or having a stillbirth. Funding: Australian National Health and Medical Research Counci

Multifactorial evaluation of atenolol, caffeine, carbamazepine and ibuprofen on raphidocelis subcapitata and chlorella vulgaris

Micropollutants in aquatic resources have raised global concerns regarding the conservation of ecosystems. Although they are usually found in the environment at trace concentrations to a maximum of several µg/L, it is still necessary to address the potential risks these pollutants may represent to organisms. A multifactor analysis was conducted using two algae as bioindicators. Four different pharmaceuticals were chosen based on their occurrence in domestic wastewaters and persistency after biological treatment processes ranging from 1/8th to four-fold representative environmental concentrations over 96 h exposure. The present multifactor analysis evaluated cell size, photosynthetic capacity and growth rate. These data were later combined into a simplified single entity: “the index effect”. The results obtained showed that, even at concentrations below the environmentally relevant concentrations (ERC), the pharmaceuticals’ residues (PRs), caused a cellular behavioural variation in both organisms. In addition, the algae cultures’ response to exposure to these stressors was generally dependent on the concentration over time. By examining four different PR over three different characteristics of two types of algal bioindicators, this work covers significant and specific responses on the algae exposure cycle. This is unique research since most studies do not consider multiple parameters in the assessment of the environment risk for bioindicators

Developing type 1 diabetes resources: a qualitative study to identify resources needed to upskill and support community sport coaches

IntroductionCommunity sport coaches in Western Australia lack an understanding, the confidence, and knowledge in supporting young people with Type 1 diabetes (T1D). This study aims to identify what T1D educational resources are required to upskill coaches in Western Australia.MethodsSemi-structured online interviews were conducted with i) young people living with T1D, ii) parents of young people living with T1D and iii) community sport coaches. The questions explored i) past experiences of T1D management in community sport ii) the T1D information coaches should be expected to know about and iii) the format of resources to be developed. Thematic analysis of interview transcripts was performed, and the themes identified were used to guide resource development.ResultsThirty-two participants (16 young people living with T1D, 8 parents, 8 coaches) were interviewed. From the interviews, young people wanted coaches to have a better understanding of what T1D is and the effect it has on their sporting performance, parents wanted a resource that explains T1D to coaches, and sports coaches wanted to know the actions to best support a player living with T1D. All groups identified that signs and symptoms of hypoglycaemia and hyperglycaemia needed to be a key component of the resource. Sports coaches wanted a resource that is simple, quick to read and available in a variety of different formats.ConclusionThe interviews resulted in valuable information gained from all groups and have reinforced the need for the development of specific resources to increase community knowledge and provide support for players with T1D, parents and sport coaches

Household vacuum cleaners vs. the high-volume surface sampler for collection of carpet dust samples in epidemiologic studies of children

<p>Abstract</p> <p>Background</p> <p>Levels of pesticides and other compounds in carpet dust can be useful indicators of exposure in epidemiologic studies, particularly for young children who are in frequent contact with carpets. The high-volume surface sampler (HVS3) is often used to collect dust samples in the room in which the child had spent the most time. This method can be expensive and cumbersome, and it has been suggested that an easier method would be to remove dust that had already been collected with the household vacuum cleaner. However, the household vacuum integrates exposures over multiple rooms, some of which are not relevant to the child's exposure, and differences in vacuuming equipment and practices could affect the chemical concentration data. Here, we compare levels of pesticides and other compounds in dust from household vacuums to that collected using the HVS3.</p> <p>Methods</p> <p>Both methods were used in 45 homes in California. HVS3 samples were collected in one room, while the household vacuum had typically been used throughout the home. The samples were analyzed for 64 organic compounds, including pesticides, polycyclic aromatic hydrocarbons, and polychlorinated biphenyls (PCBs), using GC/MS in multiple ion monitoring mode; and for nine metals using conventional microwave-assisted acid digestion combined with ICP/MS.</p> <p>Results</p> <p>The methods agreed in detecting the presence of the compounds 77% to 100% of the time (median 95%). For compounds with less than 100% agreement, neither method was consistently more sensitive than the other. Median concentrations were similar for most analytes, and Spearman correlation coefficients were 0.60 or higher except for allethrin (0.15) and malathion (0.24), which were detected infrequently, and benzo(k)fluoranthene (0.55), benzo(a)pyrene (0.55), PCB 105 (0.54), PCB 118 (0.54), and PCB 138 (0.58). Assuming that the HVS3 method is the "gold standard," the extent to which the household vacuum cleaner method yields relative risk estimates closer to unity by increasing random measurement error varies by compound and depends on the method used to calculate relative risk.</p> <p>Conclusion</p> <p>The household vacuum cleaner method appears to be a reasonable alternative to the HVS3 for detecting, ranking, and quantifying the concentrations of pesticides and other compounds in carpet dust.</p

Observed Reductions in Schistosoma mansoni Transmission from Large-Scale Administration of Praziquantel in Uganda: A Mathematical Modelling Study

To date schistosomiasis control programmes based on chemotherapy have largely aimed at controlling morbidity in treated individuals rather than at suppressing transmission. In this study, a mathematical modelling approach was used to estimate reductions in the rate of Schistosoma mansoni reinfection following annual mass drug administration (MDA) with praziquantel in Uganda over four years (2003-2006). In doing this we aim to elucidate the benefits of MDA in reducing community transmission.Age-structured models were fitted to a longitudinal cohort followed up across successive rounds of annual treatment for four years (Baseline: 2003, TREATMENT: 2004-2006; n = 1,764). Instead of modelling contamination, infection and immunity processes separately, these functions were combined in order to estimate a composite force of infection (FOI), i.e., the rate of parasite acquisition by hosts.MDA achieved substantial and statistically significant reductions in the FOI following one round of treatment in areas of low baseline infection intensity, and following two rounds in areas with high and medium intensities. In all areas, the FOI remained suppressed following a third round of treatment.This study represents one of the first attempts to monitor reductions in the FOI within a large-scale MDA schistosomiasis morbidity control programme in sub-Saharan Africa. The results indicate that the Schistosomiasis Control Initiative, as a model for other MDA programmes, is likely exerting a significant ancillary impact on reducing transmission within the community, and may provide health benefits to those who do not receive treatment. The results obtained will have implications for evaluating the cost-effectiveness of schistosomiasis control programmes and the design of monitoring and evaluation approaches in general

Determinants of Agricultural Pesticide Concentrations in Carpet Dust

Background: Residential proximity to agricultural pesticide applications has been used as a surrogate for exposure in epidemiologic studies, although little is known about the relationship with levels of pesticides in homes

Ethanol reversal of tolerance to the respiratory depressant effects of morphine

Opioids are the most common drugs associated with unintentional drug overdose. Death results from respiratory depression. Prolonged use of opioids results in the development of tolerance but the degree of tolerance is thought to vary between different effects of the drugs. Many opioid addicts regularly consume alcohol (ethanol), and post-mortem analyses of opioid overdose deaths have revealed an inverse correlation between blood morphine and ethanol levels. In the present study, we determined whether ethanol reduced tolerance to the respiratory depressant effects of opioids. Mice were treated with opioids (morphine, methadone, or buprenorphine) for up to 6 days. Respiration was measured in freely moving animals breathing 5% CO(2) in air in plethysmograph chambers. Antinociception (analgesia) was measured as the latency to remove the tail from a thermal stimulus. Opioid tolerance was assessed by measuring the response to a challenge dose of morphine (10 mg/kg i.p.). Tolerance developed to the respiratory depressant effect of morphine but at a slower rate than tolerance to its antinociceptive effect. A low dose of ethanol (0.3 mg/kg) alone did not depress respiration but in prolonged morphine-treated animals respiratory depression was observed when ethanol was co-administered with the morphine challenge. Ethanol did not alter the brain levels of morphine. In contrast, in methadone- or buprenorphine-treated animals no respiratory depression was observed when ethanol was co-administered along with the morphine challenge. As heroin is converted to morphine in man, selective reversal of morphine tolerance by ethanol may be a contributory factor in heroin overdose deaths

A controlled trial of mental illness related stigma training for medical students

Article deposited according to agreement with BMC, December 6, 2010.YesFunding provided by the Open Access Authors Fund

Reconstruction of ice-sheet changes in the Antarctic Peninsula since the Last Glacial Maximum

This paper compiles and reviews marine and terrestrial data constraining the dimensions and configuration of the Antarctic Peninsula Ice Sheet (APIS) from the Last Glacial Maximum (LGM) through deglaciation to the present day. These data are used to reconstruct grounding-line retreat in 5ka time-steps from 25kaBP to present. Glacial landforms and subglacial tills on the eastern and western Antarctic Peninsula (AP) shelf indicate that the APIS was grounded to the outer shelf/shelf edge at the LGM and contained a series of fast-flowing ice streams that drained along cross-shelf bathymetric troughs. The ice sheet was grounded at the shelf edge until ~20calkaBP. Chronological control on retreat is provided by radiocarbon dates on glacimarine sediments from the shelf troughs and on lacustrine and terrestrial organic remains, as well as cosmogenic nuclide dates on erratics and ice moulded bedrock. Retreat in the east was underway by about 18calkaBP. The earliest dates on recession in the west are from Bransfield Basin where recession was underway by 17.5calkaBP. Ice streams were active during deglaciation at least until the ice sheet had pulled back to the mid-shelf. The timing of initial retreat decreased progressively southwards along the western AP shelf; the large ice stream in Marguerite Trough may have remained grounded at the shelf edge until about 14calkaBP, although terrestrial cosmogenic nuclide ages indicate that thinning had commenced by 18kaBP. Between 15 and 10calkaBP the APIS underwent significant recession along the western AP margin, although retreat between individual troughs was asynchronous. Ice in Marguerite Trough may have still been grounded on the mid-shelf at 10calkaBP. In the Larsen-A region the transition from grounded to floating ice was established by 10.7-10.6calkaBP. The APIS had retreated towards its present configuration in the western AP by the mid-Holocene but on the eastern peninsula may have approached its present configuration several thousand years earlier, by the start of the Holocene. Mid to late-Holocene retreat was diachronous with stillstands, re-advances and changes in ice-shelf configuration being recorded in most places. Subglacial topography exerted a major control on grounding-line retreat with grounding-zone wedges, and thus by inference slow-downs or stillstands in the retreat of the grounding line, occurring in some cases on reverse bed slopes

The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting