Preconception substance use and risk of unintended pregnancy

Background: In the United States, unintended pregnancy is a serious public health issue due to its persistent high prevalence. In the series of three studies, our first two investigations examined the risk and potential determinants of unintended pregnancy among substance and polysubstance using women of childbearing age. In the third study, we conducted a systematic review (SR) with meta-analysis (MA) to assess the association of illicit and recreational drugs to the risk of unintended pregnancy. Methods: We performed a secondary data analysis on a subset of Pregnancy Risk Assessment Monitoring System (PRAMS) 2016-17 phase 8 data (n=75,543). The outcome variable was pregnancy intention. The exposure variable was substance use, including alcohol, cannabis, nicotine/tobacco, illicit/recreational drugs, and special medications, including prescription opioids, over-the-counter pain relief, and antidepressants. In the second study, the exposure variable was the use of alcohol in concert with other substances. We also evaluated the relation of specific sociodemographic and economic variables to the risk of unintended pregnancy. Data were analyzed using complex survey analysis. For the SR with MA, predetermined criteria were used to ascertain study eligibility. To identify eligible original studies for the full review, we screened abstracts from six electronic databases (PubMed (MEDLINE), Scopus, CINAHL, PsychINFO, and Web of Science) and citation indices from retrieved articles and recent reviews. The inverse variance method was used to calculate the pooled effect size. Results: Overall, 41% of pregnancies were unintended. Approximately 57% of participants reported alcohol consumption, 17% reported smoking, and 10% cannabis use prior to conception. Study 1: Likelihood of unintended pregnancy was significantly associated with substance use, including cigarettes (Adjusted Odds Ratio (AOR):1.5, 95% CI: 1.4-1.6); use of other nicotine/tobacco products (AOR:1.4, 95% CI: 1.3-1.5); cannabis (AOR: 1.9, 95% CI: 1.5-2.3); illicit/recreational drugs (AOR:1.7, 95% CI: 1.2-2.4), prescription opioids (AOR:1.4, 95% CI: 1.02-1.9), and prescription antidepressants (AOR 1.8, 95% CI: 1.1-3.0). Among substance users, factors significantly associated with unintended pregnancy included maternal age \u3c17, living in urban areas, lower educational attainment, annual income Study 2: The likelihood of unintended pregnancy was significantly elevated in those reporting co-use of alcohol with cigarette smoking (AOR: 1.5, 95%CI:1.4 – 1.6), cannabis (AOR: 2.0, 95%CI:1.6 – 2.4), tobacco/nicotine (AOR: 1.6, 95%CI:1.4 – 1.7), and illicit/recreational drugs (AOR: 1.8, 95%CI: 1.1 – 2.7). In addition, living in urban areas, income below the federal poverty level, and not being married were significant predictors of unintended pregnancy. Study 3: Our SR with MA included eight observational studies (N=38,520 women). Pooled findings indicated that illicit and recreational drugs use during the preconception period was significantly and positively associated with the likelihood of unintended pregnancy (pooled odds ratio (POR)=1.84, 95% CI: 1.4-2.4). Conclusion: Findings of our two studies in a large representative sample of US women suggest that substance and polysubstance use during the preconception period significantly increases the likelihood of unintended pregnancy. Consistent with these results, the pooled findings of our SR with MA indicated a significant and positive association between the use of illicit and recreational drugs and the risk of unintended pregnancy. Collectively, these findings support a potential causal link between preconception substance use and subsequent risk of unintended pregnancy. These findings highlight the need for tailored screening, educational, and treatment programs and integrated family planning services to help reduce both substance use and unintended pregnancy among women of childbearing age

Governance and Income Inequality

Major problems of developing countries are unequal income distribution and low growth rate, which affect their welfare aspects. It was implicitly assumed that whenever we achieve target of higher growth rate, benefit of growth would automatically trickle down to the poor. History of developing countries shows that the rich benefited more than the poor as evidenced by rising income inequality during the period of higher economic growth. The economic policy changes are often triggered by the logic of low level of equilibrium of output level, employment and income distribution. To overcome this low level of equilibrium trap, government often adopt polices so as to achieve high level of income and employment growth and development, and equitable income distribution. Coherent policy instruments are essential to meet these policy targets. Impact of any macro economic policy has been examined by studying its impact on economic growth and income distribution. In recent years polices have been directed toward reducing the level of poverty and inequality through raising quality of life in society by providing efficient and effective governance. This new economic philosophy has resulted in a massive change in the policy orientation of countries; the priority is now centred on issue of governance and focus is now shifted towards a qualitative nature of its growth and development. According to Sen (1983), the realisation of human capabilities, that enlarge the range of human choices, is essential for a broader notion and measure of economic well-being. The institutional frame work is then considered as one of the essential elements for translating growth and well-being into a sustainable process

Impact of water management on agricultural production

This paper explores the impact of water management on output, labor, and capital growth for an agriculture-based developing economy like Pakistan. According to empirical findings, capital stock and labor force in the agriculture sector significantly affect output growth. Improvement of capital stock in the form of mechanization, improved seeds, fertilizers and pesticides on one hand, and labor force skills, techniques and management, on the other hand, will bring positive and significant impact on agricultural output. Any improvement in policy management by authorities will enhance agricultural production manifold. Water at farm gate, tube wells, and access to credit of farmers increase agricultural output by enhancing the productivity of capital and labor. Proper water management will result in efficient allocation of resources and has an indirect positive impact on growth of output. To increase overall efficiency, an irrigation technology that efficiently uses water for intensive crop production must be developed

Impact of water management on agricultural production

This paper explores the impact of water management on output, labor, and capital growth for an agriculture-based developing economy like Pakistan. According to empirical findings, capital stock and labor force in the agriculture sector significantly affect output growth. Improvement of capital stock in the form of mechanization, improved seeds, fertilizers and pesticides on one hand, and labor force skills, techniques and management, on the other hand, will bring positive and significant impact on agricultural output. Any improvement in policy management by authorities will enhance agricultural production manifold. Water at farm gate, tube wells, and access to credit of farmers increase agricultural output by enhancing the productivity of capital and labor. Proper water management will result in efficient allocation of resources and has an indirect positive impact on growth of output. To increase overall efficiency, an irrigation technology that efficiently uses water for intensive crop production must be developed

Last Decade of Dengue – and the Next One

AbstractBackground: Before 1970, only 9 countries had dengue. Until 1998, there were 1.2 billion dengue infected cases in 56 different countries around the globe. To date it is prevalent in all of 6 WHO regions. Mortality rate is thought to be 2.5% as it varies from country to country. These figures are not surely depicting exact situation as many cases from most parts of the underdeveloped and developing countries go unreported due to number of reasons but one thing is sure that it is on accelerating note.Methodology: In this study, total number of dengue victims around the globe from year 2000-2009 was estimated. Data were collected from World Health Organization (WHO), different health and country specific emergency dealing agenciesand hospitals. We have shown dengue statistics in annotated maps of international regions where dengue has affected in certain.  In a country specific (Pakistan) study we have determined most vulnerable population group among society, their age, gender and immunological profile against dengue virus. Moreover, most prevalent serotype of dengue virus is determined by surveying the current data.Results: It is estimated that there were 24,956 lives lost world wide during 2000-2009 as a consequence of dengue infection (DF/DHF/DSS) with an average CFR of 0.24%. These figures are approximate as we have not included the unauthentic source figures from non-reporting (to WHO) countries or not having an official database. A total of 10,178,624 clinical cases had been reported during that period with highest share of Americas of 6,586,785 cases.Conclusion: Our estimate suggests that number of dengue cases got elevated in first decade of 21st century but death rate is not that higher as 2-2.5% which is estimated. Dengue is spreading and finding novel places as temperature and travelling is getting increased

Prevalence of syphilis in Pakistani blood donors

Abstract Background: Blood transfusion is one among the common sources for transmission of the infectious diseases. In Pakistan, a country of population about 1.8 billions, blood required for transfusion is approximately 1.5 million bags per year. So, evaluation of the prevalence of syphilis among the blood donors by a retrospective study is important and critical to give a vivid picture of current situation for both the donors involved and medical practitioners.  Method: A questioner was administered and consent was taken before obtaining the blood sample for the syphilis serology from all the blood donors. ARCHITECT syphilis Treponema Pallidum (TP) assay was performed to detect the syphilis.Results: There were 449 (3.1%) confirmed cases found to be syphilis positive out of total 14,352 tested individuals. We found that male population is at far higher risk than female population. Out of 179 females, only 3 (1.6%) were found to be syphilis positive and out of 14173 males, 446 (3.1%) were having syphilis infection.Conclusions: We report high prevalence of syphilis in blood donors which was unexpected as in accordance with the previous studies. This calls for mandatory syphilis screening test of donor before transfusion of blood.  As this high prevalence poses a great risk to public health, we strongly suggest that there should me be more public awareness campaign to fight against this infectious disease

Carbapenem Resistance: Mechanisms and Drivers of Global Menace

The emergence of carbapenem-resistant bacterial pathogens is a significant and mounting health concern across the globe. At present, carbapenem resistance (CR) is considered as one of the most concerning resistance mechanisms and mainly found in gram-negative bacteria of the Enterobacteriaceae family. Although carbapenem resistance has been recognized in Enterobacteriaceae from last 20 years or so, recently it emerged as a global health issue as CR clonal dissemination of various Enterobacteriaceae members especially E. coli, and Klebsiella pneumoniae are reported from across the globe at an alarming rate. Phenotypically, carbapenems resistance is in due to the two key mechanisms, like structural mutation coupled with β-lactamase production and the ability of the pathogen to produce carbapenemases which ultimately hydrolyze the carbapenem. Additionally, penicillin-binding protein modification and efflux pumps are also responsible for the development of carbapenem resistance. Carbapenemases are classified into different classes which include Ambler classes A, B, and D. Several mobile genetic elements (MGEs) have their potential role in carbapenem resistance like Tn4401, Class I integrons, IncFIIK2, IncF1A, and IncI2. Taking together, resistance against carbapenems is continuously evolving and posing a significant health threat to the community. Variable mechanisms that are associated with carbapenem resistance, different MGEs, and supplementary mechanisms of antibiotic resistance in association with virulence factors are expanding day by day. Timely demonstration of this global health concern by using molecular tools, epidemiological investigations, and screening may permit the suitable measures to control this public health menace

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe