26 research outputs found
Simulated Dataset-prenatal smoking and asthma
No full text<p>This dataset is a simulated dataset to explore and contrast Fine and Gray method with cause-specific Cox-Proportional hazards method. Please contact the author for publishing purposes. The accompanying program is a sas code that we used to fit the Fine and Gray and cause specific Cox -PH regression.</p>
Tavush Children dataset
No full text<p>This data was gathered from 6 months to 6 year old children information gathered in 2013 from Berd Region in Armenia. For more information and data dictionary please contact: [email protected]</p>
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Maternal Exposure to Mixtures of Polychlorinated Biphenyls and Early Childhood Neurodevelopmental Outcomes: A longitudinal analysis with potential mediation by impaired maternal thyroid hormones
No full textIntroductionEndocrine disrupting chemicals (EDCs) are agents, found either singly or used in mixtures, that disrupt the endocrine system or its production of hormones and may cause adverse effects in the exposed individuals or populations and, in the case of pregnant women, their offspring. It is presumed that maternal thyroid hormones contribute to fetal brain development. The EDCs that could impair maternal thyroid hormone function might result in subtle deficits in neurodevelopmental outcomes in children. Polychlorinated biphenyls (PCBs) are a class of EDCs produced in the past century and are still found in the environment.
This dissertation aims to explore, elaborate, and embellish the associations between prenatal exposure to PCBs, the metabolites associated with PCBs, and child cognitive and motor development. The next aim of this dissertation is to explore the associations between prenatal exposure to PCBs, the metabolites associated with PCBs, and maternal thyroid hormones. Five chapters are included in this dissertation: First, an introduction to PCBs and specific aims; second, a systematic review of the literature, including the studies where prenatal exposure to PCBs or the hydroxylated PCB metabolites (OH-PCBs) and their relationship with various domains of children's neurodevelopment were investigated; third, an empirical study of exploring the associations between prenatal exposure to a mixture of PCB, OH-PCBs and children cognitive and motor skills measured in different ages; fourth, an empirical study of investigating the associations between prenatal exposure to a mixture of PCB, OH-PCBs and maternal thyroid hormones with potential for investigating the mediation of possible associations observed in the third chapter by maternal thyroid hormone concentrations; fifth, a discussion of the findings, implications for public health research, and practice and conclusions.
Materials and Methods
The systematic review included peer-reviewed studies indexed in several repositories (N=71 studies) from the inception of the repositories. This systematic review of the studies measured the PCBs directly in prenatal or immediately after delivery in maternal serum, cord blood, placenta, or breast milk. The empirical studies used the data available on mothers and children from "Child Health and Development Studies." Eleven PCB congeners and five OH-PCB metabolites were measured in the maternal serum post-partum among a random subset of the participants. I used a mixture analysis, Bayesian Kernel Machine Regression (BKMR), and generalized linear models (GLM) to assess the association between concentrations of PCB congeners and OH-PCB metabolites measured three days post-partum and children's cognitive and motor skills scores at age five, and cognitive skills measured at a follow-up at ages 9-11. BKMR and GLM were also used to explore the associations between PCB congeners and OH-PCB metabolites and maternal free thyroxine (FT4) and thyroid-stimulating hormone (TSH).
Results
The systematic review found that prenatal exposure to PCBs was possibly associated with poor cognitive development and poor attention in early and middle childhood. The evidence regarding motor development, behavior, and other neurodevelopmental outcomes were not conclusive at any stage in childhood. There was an indication for sex-specific associations with worse cognition and attention scores among boys. There was also evidence in individual studies regarding the possible association between prenatal exposure to OH-PCBs and neurodevelopmental outcomes. There were significant differences between the studies in markers of exposure, exposure assessment timing, outcome assessment, and the methodological approaches to assess the association.
In the second empirical study, I found that in the crude and adjusted BKMR models among the OH-PCB metabolites, cognitive skills test scores at age five increased with each decile increase in the mixture of OH-PCB metabolites compared to when all of the metabolites were fixed at their 50th percentile among all the children and the boys and girls. These associations were largely driven by OH-PCB153 and OH-PCB146, metabolites associated with the congener PCB153.
In the third empirical study, among OH-PCB metabolites attributed to PCB congeners, I observed suggestive evidence for a positive association with maternal FT4, particularly in the highest percentile of exposure to overall OH-PCB metabolites. I did not observe an association between exposure to the mixture of PCB congeners and Maternal FT4 or TSH. Nonetheless, the overall patterns suggested a positive association between exposure to PCB congeners and maternal FT4.No associations of the overall mixture of PCBs and OH-PCB metabolites were observed with maternal TSH concentrations in the BKMR models. Nonetheless, in single metabolite risk estimates, I found that 3’-OH-PCB138 was positively associated with maternal TSH values when the 3’-OH-PCB138 was fixed at its 90th percentile compared to when it was in its 10th percentile, fixing all the other congeners in their 10th, 50th, and 90th percentiles.
Finally, there was an indication of a possible antagonistic interaction between 4-OH-PCB107 and 3’-OH-PCB-138 in the association of OH-PCBs with maternal FT4 such that 3’-OH-PCB138 tended to have a positive association with maternal FT4 when 4-OH-PCB107 was fixed in the 90th percentile and tended to have a negative association with maternal FT4 when 4-OH-PCB107 was fixed in their 10th percentile when all the other metabolites were fixed in their median value.
Conclusions
There were patterns of positive associations of OH-PCB metabolites with the children’s cognitive outcomes and maternal FT4 and maternal TSH. Nonetheless, the observed associations were weak in magnitude, often including the null value. The BKMR allowed me to explore and investigate the interactions between different components of the mixture and the overall mixture effect on the outcomes. My dissertation indicated the necessity of a holistic approach to address the impact of exposure to environmental toxins, specifically due to the detected findings regarding interactions between OH-PCB metabolites
Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study
No full textBackground: One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions. Methods: A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors. Results: Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities. Conclusion: The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need
Prevalence and determinants of stunting in a conflict-ridden border region in Armenia - a cross-sectional study
No full textBackground
Despite global efforts, stunting remains a public health problem in several developing countries. The prevalence of stunting among 0- to 5-year-old children in Armenia has increased from 17% in 2000 to 19% in 2010. A baseline study was conducted among preschool children in Berd, a region near the northeastern border of Armenia that has experienced intermittent military tension for over 20 years.
Methods
We conducted a cross-sectional study including 594 children aged 6-month- 6 years old and their caregivers in our analysis, to assess the prevalence and determinants of stunting. We calculated the anthropometric measurements and hemoglobin levels of children; analyzed children’s stool and conducted a survey with children’s caregivers. We employed the hierarchical logistic regression model to explore the predictors of stunting among 25–72 months old children and multivariable logistic regression models to investigate the predictors of stunting among 6–24 months old children. Individual and residence level variables were included in the models including anemia, minimum dietary diversity, mothers’ height, the overall duration of breastfeeding, birthweight, child’s history of diarrhea and mean socio-economic score.
Results
The prevalence of stunting was significantly higher among the 6–24 months old children (13.3%) compared to the children aged 25–72 months old (7.8%). We did not find any differences in the prevalence of stunting by place of residence in either age group. The 6–24 months old children who consumed at least four food groups during the previous day (minimum dietary diversity) had 72% lower odds of being stunted (p < 0.05). Each kilogram increase in birthweight was associated with 76% lower odds of being stunted (OR = 0.24, p < 0.01). Mother’s height significantly decreased the odds of stunting among the children 25–72- months old (OR = 0.86, p < 0.001). BMI was also a significant predictor of stunting among both age-groups.
Conclusions
The study results highlight the significance of mother’s height, birthweight, and adequate complementary feeding to reduce stunting. Further studies are needed to determine the possible association of anemia and stunting with the ongoing conflict in the region, as well as socioeconomic conditions and food insecurity in the region
Background
No full textAdapting continuing medical education for postconflict areas: assessment in Nagorno Karabagh- a qualitative stud
The impact of the COVID-19 pandemic on the mental health of healthcare workers: study protocol for the COVID-19 health care workers (HEROES) study
No full textBackground: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. Methods: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level. Results: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. Conclusions: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings.Background: Preliminary country-specific reports suggest that the COVID-19 pandemic has a negative impact on the mental health of the healthcare workforce. In this paper, we summarize the protocol of the COVID-19 HEalth caRe wOrkErS (HEROES) study, an ongoing, global initiative, aimed to describe and track longitudinal trajectories of mental health symptoms and disorders among health care workers at different phases of the pandemic across a wide range of countries in Latin America, Europe, Africa, Middle-East, and Asia. Methods: Participants from various settings, including primary care clinics, hospitals, nursing homes, and mental health facilities, are being enrolled. In 26 countries, we are using a similar study design with harmonized measures to capture data on COVID-19 related exposures and variables of interest during two years of follow-up. Exposures include potential stressors related to working in healthcare during the COVID-19 pandemic, as well as sociodemographic and clinical factors. Primary outcomes of interest include mental health variables such as psychological distress, depressive symptoms, and posttraumatic stress disorders. Other domains of interest include potentially mediating or moderating influences such as workplace conditions, trust in the government, and the country’s income level. Results: As of August 2021, ~ 34,000 health workers have been recruited. A general characterization of the recruited samples by sociodemographic and workplace variables is presented. Most participating countries have identified several health facilities where they can identify denominators and attain acceptable response rates. Of the 26 countries, 22 are collecting data and 2 plan to start shortly. Conclusions: This is one of the most extensive global studies on the mental health of healthcare workers during the COVID-19 pandemic, including a variety of countries with diverse economic realities and different levels of severity of pandemic and management. Moreover, unlike most previous studies, we included workers (clinical and non-clinical staff) in a wide range of settings
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Short-term nutrition and growth indicators in 6-month- to 6-year-old children are improved following implementation of a multidisciplinary community-based programme in a chronic conflict setting
No full textObjective: We investigated short- and long-term indicators of malnutrition and diet before and after the community-based ‘Breaking the Cycle of Poverty’ multidisciplinary intervention.
Design: A historically and geographically controlled study using data collected in 2013 and 2016. We compared the prevalence of short-term indicators (anaemia, breast-feeding duration and minimum dietary diversity) and long-term indicators (stunting and wasting) in exposed communities at two time points. We then compared these factors in geographic areas exposed or not exposed to intervention. We conducted logistic regression analyses on the 2016 sample to measure associations between living in intervention communities and child growth indicators.
Setting: Berd region, a chronic conflict zone near the north-eastern border of Armenia and Azerbaijan.
Participants: Children aged 6 months to 6 years.
Results: Analyses included data from 2013 comprising 382 children, and data from 2016 comprising 348 children living in communities where the programme was implemented, and 635 children from unexposed communities. Anaemia prevalence in exposed communities was significantly lower in 2016 v. 2013 (10·9 v. 19·1 %, P < 0·01). Minimum dietary diversity (79·0 v. 68·1 %, P < 0·001) and breast-feeding duration (13·0 v. 11·5 months, P < 0·002) were significantly improved in exposed communities. Prevalences of stunting (11·5 v. 10·2 %, P = 0·57) and wasting (4·8 v. 2·0 %, P = 0·07) were not significantly different. Odds of anaemia were significantly lower (OR = 0·24, 95 % CI 0·16, 0·36) in intervention communities.
Conclusions: Exposure to a community-based multidisciplinary intervention reduced the rate of anaemia and improved dietary indicators
Dietary and Non-Dietary Predictors of Pyrethroid Pesticides in a Cohort of Urban Pregnant Women
No full textPrenatal exposure to opioids and neurodevelopment in infancy and childhood : a systematic review
No full textAim: This systematic review aims to estimate the relationship between prenatal exposure to opioids and neurodevelopmental outcomes and examines potential sources of heterogeneity between the studies.
Methods: We searched four databases through May 21st, 2022: PubMed, Embase, PsycInfo and the Web of Science according to a specified search strings. Study inclusion criteria include: (1) cohort and case-control peer-reviewed studies published in English; (2) studies comparing neurodevelopmental outcomes among children with prenatal opioid-exposure (prescribed or used non-medically) vs. an unexposed group. Studies investigating fetal alcohol syndrome or a different primary prenatal exposure other than opioids were excluded. Two main performed data extraction using “Covidence” systematic review platform. This systematic review was conducted in accordance with PRISMA guidelines. The Newcastle-Ottawa-Scale was used for quality assessment of the studies. Studies were synthesized based on the type of neurodevelopmental outcome and the instrument used to assess neurodevelopment.
Results: Data were extracted from 79 studies. We found significant heterogeneity between studies due to their use of different instruments to explore cognitive skills, motor, and behavioral outcomes among children of different ages. The other sources of heterogeneity included: procedures to assess prenatal exposure to opioids; period of pregnancy in which exposure was assessed; type of opioids assessed (non-medical, medication used for opioid use dis-order, prescribed by health professional), types of co-exposure; source of selection of prenatally exposed study participants and comparison groups; and methods to address lack of comparability between exposed and unexposed groups. Cognitive and motor skills as well as behavior were generally negatively affected by prenatal opioid exposure, but the significant heterogeneity precluded a meta-analysis.
Conclusion: We explored sources of heterogeneity in the studies assessing the association between prenatal exposure to opioids and neurodevelopmental outcomes. Sources of heterogeneity included different approaches to participant recruitment as well as exposure and outcome ascertainment methods. Nonetheless, overall negative trends were observed between prenatal opioid exposure and neuro-developmental outcomes
