863 research outputs found
Repeat abortion and use of contraception among post-abortion women in Nepal – A prospective cohort study
No full textThesis (Master's)--University of Washington, 2015University of Washington Abstract Repeat abortion and use of contraceptive among post-abortion women in Nepal – A prospective cohort study Aradhana Thapa Chair of the Supervisory Committee: Research Professor, Annette L. Fitzpatrick Department of Family Medicine and Epidemiology Adjunct, Department of Global Health Aim: The study aims to identify the associated risk factors of repeat abortions and post-abortion contraceptive use among women in Pokhara city of Nepal. Background: Nepal legalized abortion in 2002 to promote safer motherhood (7). Safe abortion was attributed to be one of the contributing factors to a sharp decline of maternal mortality and morbidity in the country (9), however, abortion should not be considered an alternative to contraceptive use. Choosing abortions, repeatedly, can be detrimental to women and child health (11, 12). Post-abortion acceptance of contraception is low (41%) in the country and repeat abortion, high (33%) (8,11). Method: This is a prospective cohort study conducted among women who had just received an abortion procedure between January 2015 to April 2015 at three abortion clinics of Pokhara city in Nepal. We recruited 220 women immediately after their abortions to conduct a baseline interview and followed these in-person interviews with a telephone interview two months later to collect information on each woman’s current contraceptive method. Findings: The present study revealed that only half of the post-abortion women use effective contraception after abortion and there is a high prevalence of repeat abortion. The main factors positively influencing use of post-abortion contraception were presence of the woman’s husband in another country and choice of Tier II contraceptive methods. The main risk factors identified for repeat abortion were age and age at first pregnancy. Better educated women were less likely to adopt effective contraceptive measure after abortion. Conclusion: Considering low contraception use after abortion, increasing numbers of abortion, and high incidence of repeat abortion, a well targeted intervention may have substantial effect to reduce risk of unintended pregnancies
Cardiometabolic Risk Factors Among Rural and Non-Rural Adults in Nepal
No full textThesis (Master's)--University of Washington, 2023University of Washington Abstract Cardiometabolic Risk Factors Among Rural and Non-Rural Adults in Nepal Biraj Neupane Chair of the Supervisory Committee: Annette L. Fitzpatrick, PhD
Department of Epidemiology Disparities in cardiometabolic diseases, including heart disease, stroke, diabetes, and kidney disease, have been documented globally across socioeconomic status. While decreasing in high-income nations, cardiovascular disease (CVD) mortality and noncommunicable disease (NCD) prevalence have increased in low- and middle-income countries (LMICs). The burden of cardiometabolic disorders remains a major concern in Nepal where their distribution in rural and urban areas are poorly understood. We combined data from the Dhulikhel Heart Study (DHS), an observational cohort study representing an urban setting, and the Personalized Health Program (PHP), which collected similar data in four rural regions, to compare the prevalence of selected risk factors for cardiometabolic disease by rural/urban setting in Nepalese adults. We assessed the associations between two outcomes, overweight/obesity and hypertension, with rural/urban residency and selected demographic and lifestyle characteristics of the sample. The data from DHS (N=1061) and PHP (N=3288) were harmonized to provide variables with the same values. Overweight/obesity was defined as BMI > 25 and hypertension was defined as systolic blood pressure > 140 or diastolic blood pressure > 90. Covariates included age, gender, ethnicity, education, marital status, smoking, alcohol use, and physical activity. Multivariable logistic regression was used to evaluate the odds of increased overweight/obesity and hypertension by rural/urban setting adjusted for potential confounders. In adjusted models, living in an urban setting increased the odds of being overweight/obese two-fold (OR:2.14, 95% CI: 1.57-2.93, p<0.001). Increased age, female gender, higher education, being married, Newar ethnicity, and current consumption of alcohol were significant association with being overweight/obese. The odds of having hypertension were also doubled for urban residents (OR:2.12, 95% CI:1.55-2.90, p< 0.001) adjusted for demographic and lifestyle. Gender, age, education, marital status, ethnicity, and physical activity were also significantly associated with hypertension. These results provide insights into the distribution and impact of behavioral and lifestyle-related risk factors on cardiometabolic conditions in different settings in Nepal. The findings may be used to inform targeted interventions and tailored healthcare approaches to address the specific challenges faced by each population
Joan Fitzpatrick: In Memoriam
No full textJoan Fitzpatrick graduated from Harvard Law School in 1975. Women were then beginning to enter the legal profession in increasing numbers, but role models were still important in encouraging women to become equal partners in our profession. Joan was an especially effective role model for our students. I think she realized that. It was one of the things that drove her to excel in everything she did. Joan told me—more than once in fact—that she earned every penny she made. It was a point of pride to her. She was a hard worker whose work yielded very important results. And she was the kind of teacher who would make students think: If Professor Fitzpatrick can do that, then I can also do great and important things. Joan joined our faculty in 1984. In her eighteen years with us, she became an internationally known and respected authority on human rights. She was a primary author or editor of six books, the author or co-author of fourteen book chapters, and the author or co-author of about forty scholarly articles. Joan spoke on issues of international human rights throughout North America and Europe. In the words of one of her admirers, she was brilliant, eloquent, and internationally renowned
Male-female relatedness and patterns of male reproductive investment in guppies
No full textInbreeding can cause reductions in fitness, driving the evolution of pre- and postcopulatory inbreeding avoidance mechanisms. There is now considerable evidence for such processes in females, but fewstudies have focused on males, particularly in the context of postcopulatory inbreeding avoidance. Here, we address this topic by exposing male guppies (Poecilia reticulata) to either full-sibling or unrelated females and determining whether they adjust investment in courtship and ejaculates. Our results revealed that males reduce their courtship but concomitantly exhibit short-term increases in ejaculate quality when paired with siblings. In conjunction with prior work reporting cryptic female preferences for unrelated sperm, our present findings reveal possible sexually antagonistic counter-adaptations that may offset postcopulatory inbreeding avoidance by females. © 2014 The Author(s)
Non 3-choosable bipartite graphs and the Fano plane
No full textIt is known that the smallest complete bipartite graph which is not 3-choosable has 14 vertices. We show that the extremal configuration is unique.PT: J; CR: BROWN E, 2002, MATH MAG, V75, P83 ERDOS P, 1979, CONGRESSUS NUMERANTI, V26, P155 FITZPATRICK SL, DMS854IR U VICT DEP HAUSON D, 1996, ARS COMBINATORIA, V44, P183 VIZING VG, 1976, DISKRET ANAL, V29, P3 WOODALL DR, 2001, LONDON MATH SOC LECT, V288, P269; NR: 6; TC: 0; J9: ARS COMB; PG: 15; GA: 948CQSource type: Electronic(1
metomi/rose: Rose 2.4.2
No full textSee CHANGES.md for details.Matt Shin, Ben Fitzpatrick, Andrew Clark, Oliver Sanders, Tim Pillinger, Ronnie Dutta, Sadie L. Bartholomew, Stuart Whitehouse, David Matthews, Stephen Oxley, Tomek Trzeciak, Declan Valters, Hilary James Oliver, Joe Mancell, Melanie Hall, Tom Coleman, Harry Shepherd, Annette Osprey, Jon Seddon, … Paul Cresswell. (2025). metomi/rose: Rose 2.4.2 (2.4.2). Zenodo. https://doi.org/10.5281/zenodo.1516921
metomi/rose: Rose 2.4.0
No full textSee CHANGES.md for details.Matt Shin, Ben Fitzpatrick, Andrew Clark, Oliver Sanders, Tim Pillinger, Ronnie Dutta, Sadie L. Bartholomew, Stuart Whitehouse, David Matthews, Stephen Oxley, Tomek Trzeciak, Declan Valters, Hilary James Oliver, Joe Mancell, Melanie Hall, Tom Coleman, Harry Shepherd, Annette Osprey, Jon Seddon, … Paul Cresswell. (2025). metomi/rose: Rose 2.4.0 (2.4.0). Zenodo. https://doi.org/10.5281/zenodo.1462067
metomi/rose: Rose 2.3.2
No full textSee CHANGES.md for details.Matt Shin, Ben Fitzpatrick, Andrew Clark, Oliver Sanders, Tim Pillinger, Ronnie Dutta, Sadie L. Bartholomew, Stuart Whitehouse, David Matthews, Stephen Oxley, Tomek Trzeciak, Declan Valters, Hilary James Oliver, Joe Mancell, Melanie Hall, Tom Coleman, Harry Shepherd, Annette Osprey, Jon Seddon, … Paul Cresswell. (2024). metomi/rose: Rose 2.3.2 (2.3.2). Zenodo. https://doi.org/10.5281/zenodo.1409637
metomi/rose: Rose 2.4.1 [CODE]
No full textSee CHANGES.md for details.Matt Shin, Ben Fitzpatrick, Andrew Clark, Oliver Sanders, Tim Pillinger, Ronnie Dutta, Sadie L. Bartholomew, Stuart Whitehouse, David Matthews, Stephen Oxley, Tomek Trzeciak, Declan Valters, Hilary James Oliver, Joe Mancell, Melanie Hall, Tom Coleman, Harry Shepherd, Annette Osprey, Jon Seddon, … Paul Cresswell. (2025). metomi/rose: Rose 2.4.1 (2.4.1). Zenodo. https://doi.org/10.5281/zenodo.1492530
Putting teeth into the developmental origins hypothesis: A longitudinal study of early childhood malnutrition, enamel hypoplasia and adolescent health in Amazonian Bolivia
No full textThesis (Ph.D.)--University of Washington, 2016-06Adult teeth may chronologically reflect early childhood experience because enamel on the permanent teeth calcifies incrementally during early childhood and is sensitive to physiological stress. Defects in the enamel do not repair after occurrence or during the life course, leaving a permanent biological mark of physiological insults that occurred during early childhood. These characteristics suggest enamel defects may serve as a useful biomarker of chronic malnutrition and thus predictor of long-term health. This dissertation sought to investigate associations between malnutrition-related early childhood exposures and dental enamel hypoplasia (EH) and to evaluate EH as a predictor of adolescent anthropometrics and biomarkers. We conducted analyses using data from 349 Tsimane’ adolescents in Amazonian Bolivia, collected between 2002-2010 and in 2015. In 2015, we examined EH in the permanent maxillary incisors and mandibular canines using digital photography from which the following measures of EH were abstracted: occurrence (any, none), extent of occurrence (<1/3, 1/3-2/3, >2/3 of the tooth surface) and estimated age at occurrence (1, 2, 3, 4 years of age). Data on malnutrition-related early childhood exposures (1-4 years of age) were collected between 2002 and 2010, including stunted growth (height-for-age z-scores, HAZ), underweight (weight-for-age z-scores, WAZ), anemia (hemoglobin), immune activation (c-reactive protein) and parasitic gastrointestinal infection (hookworm infection). Adolescent outcomes (10-17 years of age) were collected in 2015 and included anthropometrics (height, weight, body mass index (BMI)) and biomarkers (hemoglobin (Hb), glycated hemoglobin (HbA1c), white blood cell count (WBC) and blood pressure). First, we evaluated the reliability of EH measurement using digital photographs and the Modified DDE (developmental defects in the enamel) Index by investigating inter- and intra-rater reliability and evaluating the frequency of EH detection across examiners for systemic biases. Next, we investigated associations between several malnutrition-related childhood exposures and EH in the permanent central maxillary incisors using multivariate log-binomial and ordinal logistic regression as well as generalized estimating equations (GEE). Finally, we investigated EH in the permanent central maxillary incisors (as a marker of early childhood experience) in relation to anthropometrics and biomarkers in adolescence using multivariate linear regression. We further evaluated the accuracy of EH in the permanent central maxillary incisors as a marker of chronic malnutrition and utility as a predictor of subsequent health outcomes compared to growth stunting through sensitivity, specificity and receiver operating characteristics (ROC) analyses. Our evaluation of the digital photographs revealed a rough, cobblestone-like EH pattern in the tooth surface that was particularly prevalent in the study sample (92.3%) and was thus the focus of this project. EH detection was most common on the central maxillary incisors (87%) compared to the lateral maxillary incisors (63%) and mandibular canines (26%). The intra-examiner reliability for detecting EH occurrence on the central maxillary incisors was very good (mean kappa=0.77) and greater than the lateral maxillary incisors (mean kappa=0.68) and mandibular canines (mean kappa=0.49). However, the inter-examiner reliability was fair to poor, though the inter-examiner reliability was also better for the maxillary incisors (mean kappa= 0.29) than the mandibular canines (mean kappa=0.17). The study sample had a high prevalence of childhood malnutrition, demonstrated by prevalence of stunted linear growth (75.2%), anemia (56.9%), elevated immune activation (39.1%), and gastrointestinal hookworm infection (49.6%) between 1 and 4 years of age. Results indicated an association between average childhood HAZ (PR=0.98, 95% CI: 0.95, 1.00), CRP levels (PR=1.01, 95% CI: 1.00, 1.03) and presence of gastrointestinal hookworm infection (OR=0.28, 95% CI: 0.08, 0.94 for <1/3 vs. >2/3 of the tooth affected by EH) and EH, though some of the point estimates lacked statistical precision. Extent of the tooth surface affected by EH seemed to be an important measure of EH as it related to early childhood exposures, particularly for average HAZ and hookworm infection. Greater extent of EH on the tooth surface was also associated with adolescent outcomes, including shorter height (-0.14 HAZ, 95% CI: -0.24, -0.03 and -1.35 cm, 95% CI: -2.21, -0.50), lower weight (-0.98 kg, 95% CI: -1.73, -0.23), lower Hb (-0.36 g/dL, 95% CI: -0.59, -0.13), lower HbA1c (-0.04 %A1c, 95% CI: -0.08, -0.00), and higher WBC count (0.74 109/L, 95% CI: 0.35, 1.14) but not BMI-for-age z-score or blood pressure. EH extent was associated with anemia (PR=1.08, 95% CI: 1.00, 1.18) and elevated WBC count (PR=1.12, 95% CI: 1.01, 1.26) based on public health and clinically-relevant thresholds. When evaluated against growth stunting as the “gold standard” (HAZ< -2.0: prevalence = 62.3% in childhood and 34.1% in adolescence), EH had high sensitivity (93% in childhood, 96% in adolescence) and low specificity (11% in childhood, 10% in adolescence). EH extent was a more accurate marker of childhood stunting (AUC 0.56) than EH occurrence (AUC 0.52) due to increased specificity (0.36 vs. 0.11). The addition of EH extent to a set of markers for childhood stunting (gender and adolescent HAZ) only slightly improved the AUC (0.77 vs. 0.76, p=ns). The AUC for adolescent WBC count was greater for EH extent (AUC 0.61) than for childhood HAZ (AUC 0.58, p=ns) and adolescent HAZ (AUC 0.59, p=ns). Addition of EH extent to sets of markers for adolescent health outcomes (age, gender, childhood HAZ and adolescent HAZ) improved the AUC for nearly all outcomes. In conclusion, we detected an EH pattern that was nearly ubiquitous in the study sample, but the rough, cobblestone-like hypoplastic pattern does not fit the typical linear/grooved pattern described in the overwhelming majority of the malnutrition literature. The pattern does not provide evidence in support of a systemic cause. Intra-examiner reliability results suggest that digital photography is a reproducible method for capturing EH, particularly for the central maxillary incisors. The inter-examiner reliability results bring into question the reliability of the digital photography method, but may be explained by systemic biases between the examiners, the subjective measures included in the Modified DDE Index, insufficient examiner training, and the very high prevalence of EH in the study sample. Improvements in examiner training and the measurement index used to classify EH would likely improve inter-examiner reliability. We provided evidence in support of a relationship between early childhood chronic malnutrition (HAZ), immune activation (CRP), parasitic infection (helminth infection) and EH and between EH extent and several adverse anthropometric and biomarker measures, including shorter height and lower weight, lower hemoglobin and greater WBC count. Given that chronic malnutrition and adverse health outcomes are associated with increased mortality, our findings are in line with the bioarchaeological findings. EH extent also seemed to capture a childhood exposure relevant to adolescent HAZ, hemoglobin and WBC count outcomes above and beyond that of childhood anthropometrics. Although not a strong proxy measure for chronic malnutrition, EH extent may be an important measure for predicting adolescent health outcomes. EH extent may serve as a useful proxy measure of childhood experience among adolescents in settings where childhood stunting data is not available. Furthermore, EH extent may capture childhood exposures relevant to adolescent health outcomes, particularly WBC count, that are not captured by childhood or adolescent HAZ and may thus be a useful addition to the “toolkit” of chronic malnutrition markers. This project makes a unique contribution to the existing literature because it prospectively recorded multiple early childhood exposures (beyond height or stunted growth) and had the minimum follow-up time necessary for full eruption of the permanent dentition to demonstrate an association between malnutrition-related childhood exposures, EH in the permanent dentition and adverse adolescent health outcomes. Subsequent work that builds on this project will be directed toward improving measurement of EH, including further characterization of the spectrum of enamel defects observed in the human dentition, systematically investigating EH etiology across populations and further developing EH as a useful predictor of long-term health by evaluating additional health outcomes, associations in more populations and employing advanced methodology
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