Chromosomal disorders:estimating baseline birth prevalence and pregnancy outcomes worldwide

Chromosomal disorders, of which Down syndrome is the most common, can cause multi-domain disability. In addition, compared to the general population, there is a higher frequency of death before the age of five. In many settings, large gaps in data availability have hampered policy-making, programme priorities and resource allocation for these important conditions. We have developed methods, which overcome this lack of data and allow estimation of the burden of affected pregnancies and their outcomes in different settings worldwide. For example, the methods include a simple equation relating the percentage of mothers 35 and over to Down syndrome birth prevalence. The results obtained provide a starting point for consideration of services that can be implemented for the care and prevention of these disorders

Neuroprotection by adenosine in the brain: From A1 receptor activation to A2A receptor blockade

Adenosine is a neuromodulator that operates via the most abundant inhibitory adenosine A1 receptors (A1Rs) and the less abundant, but widespread, facilitatory A2ARs. It is commonly assumed that A1Rs play a key role in neuroprotection since they decrease glutamate release and hyperpolarize neurons. In fact, A1R activation at the onset of neuronal injury attenuates brain damage, whereas its blockade exacerbates damage in adult animals. However, there is a down-regulation of central A1Rs in chronic noxious situations. In contrast, A2ARs are up-regulated in noxious brain conditions and their blockade confers robust brain neuroprotection in adult animals. The brain neuroprotective effect of A2AR antagonists is maintained in chronic noxious brain conditions without observable peripheral effects, thus justifying the interest of A2AR antagonists as novel protective agents in neurodegenerative diseases such as Parkinson’s and Alzheimer’s disease, ischemic brain damage and epilepsy. The greater interest of A2AR blockade compared to A1R activation does not mean that A1R activation is irrelevant for a neuroprotective strategy. In fact, it is proposed that coupling A2AR antagonists with strategies aimed at bursting the levels of extracellular adenosine (by inhibiting adenosine kinase) to activate A1Rs might constitute the more robust brain neuroprotective strategy based on the adenosine neuromodulatory system. This strategy should be useful in adult animals and especially in the elderly (where brain pathologies are prevalent) but is not valid for fetus or newborns where the impact of adenosine receptors on brain damage is different

Characteristics, availability and uses of vital registration and other mortality data sources in post-democracy South Africa

The value of good-quality mortality data for public health is widely acknowledged. While effective civil registration systems remains the ‘gold standard’ source for continuous mortality measurement, less than 25% of deaths are registered in most African countries. Alternative data collection systems can provide mortality data to complement those from civil registration, given an understanding of data source characteristics and data quality. We aim to document mortality data sources in post-democracy South Africa; to report on availability, limitations, strengths, and possible complementary uses of the data; and to make recommendations for improved data for mortality measurement. Civil registration and alternative mortality data collection systems, data availability, and complementary uses were assessed by reviewing blank questionnaires, death notification forms, death data capture sheets, and patient cards; legislation; electronic data archives and databases; and related information in scientific journals, research reports, statistical releases, government reports and books. Recent transformation has enhanced civil registration and official mortality data availability. Additionally, a range of mortality data items are available in three population censuses, three demographic surveillance systems, and a number of national surveys, mortality audits, and disease notification programmes. Child and adult mortality items were found in all national data sources, and maternal mortality items in most. Detailed cause-of-death data are available from civil registration and demographic surveillance. In a continent often reported as lacking the basic data to infer levels, patterns and trends of mortality, there is evidence of substantial improvement in South Africa in the availability of data for mortality assessment. Mortality data sources are many and varied, providing opportunity for comparing results and improved public health planning. However, more can and must be done to improve mortality measurement by improving data quality, triangulating data, and expanding analytic capacity. Cause data, in particular, must be improved

Moving Toward Integration? Effects of Migration on Ethnoracial Segregation Across the Rural-Urban Continuum

This study analyzes the impact of migration on ethnoracial segregation among U.S. counties. Using county-level net migration estimates by age, race, and Hispanic origin from 1990–2000 and 2000–2010, we estimate migration’s impact on segregation by age and across space. Overall, migration served to integrate ethnoracial groups in both decades, whereas differences in natural population change (increase/decrease) would have increased segregation. Age differences, however, are stark. Net migration of the population under age 40 reduced segregation, while net migration of people over age 60 further segregated people. Migration up and down the rural-urban continuum (including suburbanization among people of color) did most to decrease segregation, while interregional migration had only a small impact. People of color tended to move toward more predominantly white counties and regions at all ages. Migration among white young adults (aged 20–39) also decreased segregation. Whites aged 40 and older, however, showed tendencies toward white flight. Moderate spatial variation suggests that segregation is diminishing the most in suburban and fringe areas of several metropolitan areas in the Northeast and Midwest, while parts of the South, Southwest, and Appalachia show little evidence of integration