Quality of life after cesarean and vaginal delivery

Objective: Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery. Methods: This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum. Results: In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65±12.7 and 72.12±11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group (p<0.05). In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical (R2=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350]) and social (R2=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023]) domains of QOL and the global QOL score (R2=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]). While multiparas, there was no relationship between QOL and type of delivery. Conclusion: In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery. © OMSB, 2013

Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors

Objective: The aim of this study was to validate the World Health Organization-5 Well-Being Index (WHO-5) in a sample of pregnant Iranian women, to explore the changes in maternal well-being from pregnancy to postpartum, and to determine the factors associated with maternal well-being. Materials and Methods: This study included 341 pregnant women that presented to healthcare centers affiliated with Shahroud University of Medical Sciences, Iran, in 2011. The participants completed the General Health Questionnaire (GHQ-28) and Farsi version of WHO-5 during the third trimester of pregnancy and at 2 months postpartum. Results: Cronbach's alpha coefficient for WHO-5 items was 0.85. The correlation coefficient between WHO-5 and GHQ-28 was -0.64 (P < 0.001). Exploratory factor analysis yielded 1 factor with an eigen value equal to 3.15, which explained 63.1% of the total variance. Confirmatory factor analysis confirmed the 1-factor structure. The area under ROC curve was 0.82. A WHO-5 cut-off score of <50 exhibited optimal sensitivity (0.84) and specificity (0.59) for identifying psychological symptoms (GHQ-28 score ≥24). There was a significant difference between third trimester (58.4 ± 22) and postpartum (64.1 ± 22.3) mean WHO-5 scores (P < 0.001). Maternal level of education (OR = 1.130; 95% CI: 1.307, 1.232) was the only predictor of maternal well-being during third trimester. Breastfeeding difficulty (OR = 0.923; 95% CI: 0.882, 0.965) and maternal well-being scores during third trimester (OR = 1.038; 95% CI: 1.019, 1.058) were predictors of maternal well-being during the postpartum period. Conclusions: The Farsi version of WHO-5 was observed to be a reliable and valid instrument for screening psychological symptoms in pregnant Iranian women. The present findings show that maternal well-being improved following childbirth

Robust optimisation of urban drought security for an uncertain climate

Abstract Recent experience with drought and a shifting climate has highlighted the vulnerability of urban water supplies to “running out of water” in Perth, south-east Queensland, Sydney, Melbourne and Adelaide and has triggered major investment in water source infrastructure which ultimately will run into tens of billions of dollars. With the prospect of continuing population growth in major cities, the provision of acceptable drought security will become more pressing particularly if the future climate becomes drier. Decision makers need to deal with significant uncertainty about future climate and population. In particular the science of climate change is such that the accuracy of model predictions of future climate is limited by fundamental irreducible uncertainties. It would be unwise to unduly rely on projections made by climate models and prudent to favour solutions that are robust across a range of possible climate futures. This study presents and demonstrates a methodology that addresses the problem of finding “good” solutions for urban bulk water systems in the presence of deep uncertainty about future climate. The methodology involves three key steps: 1) Build a simulation model of the bulk water system; 2) Construct replicates of future climate that reproduce natural variability seen in the instrumental record and that reflect a plausible range of future climates; and 3) Use multi-objective optimisation to efficiently search through potentially trillions of solutions to identify a set of “good” solutions that optimally trade-off expected performance against robustness or sensitivity of performance over the range of future climates. A case study based on the Lower Hunter in New South Wales demonstrates the methodology. It is important to note that the case study does not consider the full suite of options and objectives; preliminary information on plausible options has been generalised for demonstration purposes and therefore its results should only be used in the context of evaluating the methodology. “Dry” and “wet” climate scenarios that represent the likely span of climate in 2070 based on the A1F1 emissions scenario were constructed. Using the WATHNET5 model, a simulation model of the Lower Hunter was constructed and validated. The search for “good” solutions was conducted by minimizing two criteria, 1) the expected present worth cost of capital and operational costs and social costs due to restrictions and emergency rationing, and 2) the difference in present worth cost between the “dry” and “wet” 2070 climate scenarios. The constraint was imposed that solutions must be able to supply (reduced) demand in the worst drought. Two demand scenarios were considered, “1.28 x current demand” representing expected consumption in 2060 and “2 x current demand” representing a highly stressed system. The optimisation considered a representative range of options including desalination, new surface water sources, demand substitution using rainwater tanks, drought contingency measures and operating rules. It was found the sensitivity of solutions to uncertainty about future climate varied considerably. For the “1.28 x demand” scenario there was limited sensitivity to the climate scenarios resulting in a narrow range of trade-offs. In contrast, for the “2 x demand” scenario, the trade-off between expected present worth cost and robustness was considerable. The main policy implication is that (possibly large) uncertainty about future climate may not necessarily produce significantly different performance trajectories. The sensitivity is determined not only by differences between climate scenarios but also by other external stresses imposed on the system such as population growth and by constraints on the available options to secure the system against drought. Recent experience with drought and a shifting climate has highlighted the vulnerability of urban water supplies to “running out of water” in Perth, south-east Queensland, Sydney, Melbourne and Adelaide and has triggered major investment in water source infrastructure which ultimately will run into tens of billions of dollars. With the prospect of continuing population growth in major cities, the provision of acceptable drought security will become more pressing particularly if the future climate becomes drier. Decision makers need to deal with significant uncertainty about future climate and population. In particular the science of climate change is such that the accuracy of model predictions of future climate is limited by fundamental irreducible uncertainties. It would be unwise to unduly rely on projections made by climate models and prudent to favour solutions that are robust across a range of possible climate futures. This study presents and demonstrates a methodology that addresses the problem of finding “good” solutions for urban bulk water systems in the presence of deep uncertainty about future climate. The methodology involves three key steps: 1) Build a simulation model of the bulk water system; 2) Construct replicates of future climate that reproduce natural variability seen in the instrumental record and that reflect a plausible range of future climates; and 3) Use multi-objective optimisation to efficiently search through potentially trillions of solutions to identify a set of “good” solutions that optimally trade-off expected performance against robustness or sensitivity of performance over the range of future climates. A case study based on the Lower Hunter in New South Wales demonstrates the methodology. It is important to note that the case study does not consider the full suite of options and objectives; preliminary information on plausible options has been generalised for demonstration purposes and therefore its results should only be used in the context of evaluating the methodology. “Dry” and “wet” climate scenarios that represent the likely span of climate in 2070 based on the A1F1 emissions scenario were constructed. Using the WATHNET5 model, a simulation model of the Lower Hunter was constructed and validated. The search for “good” solutions was conducted by minimizing two criteria, 1) the expected present worth cost of capital and operational costs and social costs due to restrictions and emergency rationing, and 2) the difference in present worth cost between the “dry” and “wet” 2070 climate scenarios. The constraint was imposed that solutions must be able to supply (reduced) demand in the worst drought. Two demand scenarios were considered, “1.28 x current demand” representing expected consumption in 2060 and “2 x current demand” representing a highly stressed system. The optimisation considered a representative range of options including desalination, new surface water sources, demand substitution using rainwater tanks, drought contingency measures and operating rules. It was found the sensitivity of solutions to uncertainty about future climate varied considerably. For the “1.28 x demand” scenario there was limited sensitivity to the climate scenarios resulting in a narrow range of trade-offs. In contrast, for the “2 x demand” scenario, the trade-off between expected present worth cost and robustness was considerable. The main policy implication is that (possibly large) uncertainty about future climate may not necessarily produce significantly different performance trajectories. The sensitivity is determined not only by differences between climate scenarios but also by other external stresses imposed on the system such as population growth and by constraints on the available options to secure the system against drought. Please cite this report as: Mortazavi, M, Kuczera, G, Kiem, AS, Henley, B, Berghout, B,Turner, E, 2013 Robust optimisation of urban drought security for an uncertain climate. National Climate Change Adaptation Research Facility, Gold Coast, pp. 74

Biological protection in deep space missions

During deep space missions, astronauts are exposed to highly ionizing radiation, incl. neutrons, protons and heavy ions from galactic cosmic rays (GCR), solar wind (SW) and solar energetic particles (SEP). This increase the risks for cancerogenisis, damages in central nervous system (CNS), cardiovascular diseases, etc. Large SEP events can even cause acute radiation syndrome (ARS). Long term manned deep space missions will therefor require unique radiation protection strategies. Since it has been shown that physical shielding alone is not sufficient, this paper propose pre-flight screening of the aspirants for evaluation of their level of adaptive responses. Methods for boosting their immune system, should also be further investigated, and the possibility of using radiation effect modulators are discussed. In this paper, especially, the use of vitamin C as a promising non-toxic, cost-effective, easily available radiation mitigator (which can be used hours after irradiation), is described. Although it has previously been shown that vitamin C can decrease radiation-induced chromosomal damage in rodents, it must be further investigated before any conclusions about its radiation mitigating properties in humans can be concluded

Risk estimation of heavy metals from consumption of silver pomfret and tiger tooth croaker in Hormozagan Province

In the present study, accumulation of manganese, cadmium, zinc, iron and copper in the commercially fish species (silver pomfret and tiger tooth croaker) caught from Bandarabbas coasts at 2010 was measured and the risk of daily intake of them in Hormozagan urban population was estimated. The average concentrations (µ/g dry weight) of manganese, cadmium, zinc, iron, and copper in the muscle tissue of silver pomfret were 1.248, 0.217, 14.444, 2.397 and 3.300, respectively, while the concentration of them in tiger tooth croaker were 1.009, 0.403, 12.564, 4.467 and 2.366, respectively. According to fish consumption rate, urban populations of the province were divided into four groups; low, medium, high and very high. The target hazard quotient (THQ) in each group calculated separately. The THQ of all groups were much lower than 1 in the two fish. The results showed that urban populations of the province have not any risk due to accumulation of the studied heavy metals

Ameliorative effect of Myristica fragrans (nutmeg) extract on oxidative status and histology of pancreas in alloxan induced diabetic rats

Background: Many traditional treatments have been recommended in the alternative system of medicine for the treatment of diabetes mellitus. The aim of this study was to assess oxidative stress and histological changes in the pancreas of alloxan-induced diabetic rats following Myristica fragrans seed (nutmeg) extract treatment. Materials and methods: Forty-eight male Wistar rats weighing 200–250 g were randomly divided into six groups of 8 rats each — group I, non-diabetic rats; group II, diabetic rats; groups III, IV and V, diabetic rats given orally nutmeg extract at levels of 50, 100 and 200 mg/kg, respectively; and group VI, diabetic rats given orally metformin (100 mg/kg). The experiment lasted for 28 days. Results: Data showed that nutmeg extract (100 and 200 mg/kg) significantly decreased the blood glucose levels and increased the levels of serum insulin in diabetic rats. Administration of nutmeg extract to diabetic rats reduced oxidative stress and improved the antioxidant activities in pancreatic tissue. Histopathologic results of treated groups revealed marked improvement in the morphology of the pancreas compared with the control diabetic group. In addition, number of pancreatic islets and per cent of β-cells increased significantly in these groups in comparison with diabetic untreated group. Conclusions: These results suggest that nutmeg extract has potent antidiabetic and β-cell protection activities in alloxan induced diabetic rats, possibly via its antioxidant properties

How Should Governments Address High Levels of Natural Radiation and Radon--Lessons from the Chernobyl Nuclear Accident and Ramsar, Iran

The authors discuss the high levels of natural background radiation in Ramsar, Iran, and offer data indicating that this has had little effect on the health of Ramsar\u27s inhabitants. The authors then examine the implications their research could have for public health policy