Medicine and Health Sciences Commons^™

The Impact Of Intrauterine Exposure To Gestational Diabetes Mellitus On Early Childhood Body Mass Index Trajectories, Aniq Anam

Electronic Thesis and Dissertation Repository

Background: Although gestational diabetes mellitus (GDM) has been linked to pediatric obesity, there is limited research on the impact of intrauterine exposure to GDM on trajectories of childhood growth. Objective: To assess the effect of prenatal GDM exposure on childhood body mass index (BMI) trajectories. Design: Analyses were conducted using data from cycles 2 to 6 (1994-2004; N=3412 children) of the National Longitudinal Survey of Children and Youth. Latent growth curve modelling (LGCM) was used to model BMI trajectories from age 2 to 10 years with prenatal exposure to GDM as a predictor. Effect modification by breastfeeding was assessed. Results: …

Early Chronic Low-Level Lead Exposure Produces Glomerular Hypertrophy In Young C57bl/6j Mice, Christina Sobin, John Basgen

Christina Sobin, Ph.D.

Early chronic lead exposure continues to pose serious health risks for children, particularly those living in lower socioeconomic environments. This study examined effects on developing glomeruli in young C57BL/6J mice exposed to low (30 ppm), higher (330 ppm) or no lead via dams’ drinking water from birth to sacrifice on post-natal day 28. Low-level lead exposed mice [BLL mean (SD); 3.19 (0.70) µg/dL] had an increase in glomerular volume but no change in podocyte number compared to control mice [0.03 (0.01) µg/dL]. Higher-level lead exposed mice [14.68 (2.74) µg/dL] had no change in either glomerular volume or podocyte number. The …

The Long-Term Effects Of Childhood Malnutrition On Cognitive Development: The Case Of Famine In Ghana, Ampaabeng K. Samuel, Chih Ming Tan

Economics & Finance Faculty Publications

We examine the role of early childhood health in human capital accumulation. Using a unique data set from Ghana with comprehensive information on individual, family, community, school quality characteristics and a direct measure of intelligence together with test scores, we examine the long-term cognitive effects of the 1983 famine on survivors. We show that differences in intelligence test scores can be robustly explained by the differential impact of the famine in different parts of the country and the impacts are most severe for children under two years of age during the famine. We also account for model uncertainty by using …

Full-Gestational Exposure To Nicotine And Ethanol Results In Long-Term Dysregulation In The Ventral Tegmental Area, Emily Elizabeth Roguski

Theses and Dissertations (ETD)

Nicotine is considered a gateway drug for other drugs of abuse. The majority of smokers that begin smoking in adolescence, continue into adulthood. Multiple factors have been linked with smoking initiation, including maternal smoking. Drug exposure during pregnancy has long been suspected to exert deleterious effects on the fetal brain. Concurrent use of smoking and drinking alcohol throughout pregnancy is an all too frequent occurrence in the human population especially in disadvantaged and younger women.

The present study investigated the potential contributing factors for the enhanced nicotine selfadministration as seen in offspring with gestational exposure to nicotine and ethanol (Nic+EtOH).* …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …

Short- And Long-Term Associations Between Widowhood And Mortality In The United States: Longitudinal Analyses, J. Robin Moon, M. Maria Glamour, Anusha M. Vable, Sze Yan Liu, S.V. Subramanian

Department of Public Health Scholarship and Creative Works

Background

Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this ‘widowhood effect’ persists over time.

Methods

Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

Results

Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio …

Validation Of Verbal Autopsy Tool For Ascertaining The Causes Of Stillbirth, Sidrah Nausheen, Sajid B. Soofi, Kamran Sadiq, Atif Habib, Ali Turab, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Zulfiqar A. Bhutta, Zahid Memon, Rajiv Bahl, M. Imran Khan, Shireen Bhutta

Department of Obstetrics & Gynaecology

Objective: To assess performance of the WHO revised verbal autopsy tool for ascertaining the causes of still birth in comparison with reference standard cause of death ascertained by standardized clinical and supportive data.
Methods: All stillbirths at a tertiary hospital in Karachi, Pakistan were prospectively recruited into study from August 2006- February 2008. The reference standard cause of death was established by two senior obstetricians within 48 hours using the ICD coding system. Verbal autopsy interviews using modified WHO tool were conducted by trained health workers within 2- 6 weeks of still birth and the cause of death …

The Perception Of Maternal Anemia And The Effect Of Nutritional Education: A Qualitative Analysis Among Village Mothers In Rural Kumaon, Uk, Kelsey Bash

Independent Study Project (ISP) Collection

Malnutrition is often associated with starving children in developing countries. However, while calorie and protein deficiencies—macronutrient deficiencies—are a cause for concern, micronutrient deficiencies can be equally detrimental and are even more pervasive. The most prevalent micronutrient deficiency is anemia, and the story of anemia in India is particularly grim. India has the largest number of anemic people in the world and severe anemia is the cause of death for an average of 22,000 Indians each year (The Micronutrient Initiative 2006). Anemia rates are exacerbated for women and even more so for pregnant women. According to the most recent National Family …

Is There A Viability-Vulnerability Tradeoff? Sex Differences In Fetal Programming, Curt A. Sandman, Laura M. Glynn, Elyssia Poggi Davis

Psychology Faculty Articles and Research

OBJECTIVE: In this paper we evaluate the evidence for sex differences in fetal programming within the context of the proposed viability-vulnerability tradeoff.

METHODS: We briefly review the literature on the factors contributing to primary and secondary sex ratios. Sex differences in fetal programming are assessed by summarizing previously published sex difference findings from our group (6 studies) and also new analyses of previously published findings in which sex differences were not reported (6 studies).

RESULTS: The review and reanalysis of studies from our group are consistent with the overwhelming evidence of increasing risk for viability among males exposed to environmental …

Public Perceptions On Family Planning And Birth Spacing In The Cultural And Religious Context Of Senegal: A Case Study In Dakar, Senegal, Heidi Kahle

Independent Study Project (ISP) Collection

Much prior research has examined the prevalence rates of family planning and contraceptive use in Senegal, as well as the importance of family planning for reducing maternal and infant mortality, improving the well being of families, and improving the national economy. Few studies, though, have captured the perspectives of Senegalese persons and their attitudes and beliefs toward family planning, rumors and stigmas that surround it, and how different actors can work together to dispel rumors and encourage the use of family planning. I conducted my research in Dakar, Senegal, where I interviewed a variety of persons – two gynecologists, a …

The Pertinence Of Maternal Education On Child Immunization In Rural Uttarakhand: More Than Just Increased Rates, Sarah Banerji

Independent Study Project (ISP) Collection

Child immunization rates in India continue to remain low, despite the 1985 implementation of a Universal Immunization Program that provides free basic immunizations to all children. There are numerous logistical factors that contribute to the low rates of immunization, but rates are made further worse by a lack of parental awareness and education about immunization, especially in village communities. This study examines the maternal understanding of immunization in rural Uttarakhand, both in villages in which an NGO has been working to improve maternal immunization education and in villages with no NGO involvement. It finds a positive correlation between increased immunization …

“Breastfeeding Perceptions And Practices” A Comparative Study Of Two Opposing Socio-Economic Level Quarters Within Yaoundé, Cameroon, Alexandria J. Ross

Independent Study Project (ISP) Collection

This research project aims to identify and analyze the conditions that influence breastfeeding perceptions and practices within two opposing socioeconomic level quarters of Yaoundé, Cameroon: Bastos and Madagascar. According to the World Health Organization recommendations for optimal infant and young child nutrition, mothers are advised to exclusively breastfeed for the first six months of life after birth before introducing complimentary feeding. Cameroon since 2005 has adhered to the International Code of Marketing of Breastmilk Substitutes. It is classified as a Category 1 as a country which discourages commercial pressures to feed alternative forms of nutrition known as breastmilk substitutes.

This …

Socio-Cultural Barriers To Family Planning Access, Aasha Jackson

Independent Study Project (ISP) Collection

This paper attempts to discern barriers to family planning access and use in the Manguier quarter of Yaoundé, Cameroon based on research collected during a three week period. Questionnaires and interviews were used to measure women’s use of and opinions towards family planning consultations and methods. The spread of rumors regarding negative side effects, mistaken beliefs about family planning, husband’s disapproval, and the availability of contraceptives elsewhere were found to be the major deterrents to the use of family planning by women in this study. This research shows the need for campaigns to educate women and men alike on the …

Los Determinantes De La Diferencia En La Tasa De Fecundidad Adolescente Entre Comunidades Pobres Y Ricas En Buenos Aires, Emily Turner

Independent Study Project (ISP) Collection

The city of Buenos Aires has some of the lowest rates of teenage fertility in Argentina (Gogna, Binstock, Fernández, Ibarlucía, & Zamberlin, 2008). However, this aggregated number obscures the huge variance within the city. In the most current available data (2010/2012) from the government of the city of Buenos Aires (GCBA) broken down by comunas (areas) highest fertility rate for 15-19 year olds was 81.6 births (per 1000) versus the lowest fertility rate which was only 6.2 (D. d. e. d. GCBA). This discrepancy is huge and reflects the incredible economic disparity in Buenos Aires. The comunas with the three …

La Opinión Pública Sobre El Aborto En Chile: Conceptos Públicos De Moralidad Y De Derechos De Las Mujeres En Relación Con Aborto, Sarah Smith

Independent Study Project (ISP) Collection

Background: Abortion legislation in Chile is among the most restrictive in the world, with abortion being illegal without exception. However, while abortion remains completely illegal in Chile, there are an estimated 125,000-175,000 clandestine abortions being carried out each year. Illegal abortions account for about 30% of maternal deaths in Chile. It is important to understand public opinions on abortion in order to understand this discrepancy between legislation and reality.

Research Objectives:What is the public opinion of Chileans on the legal and moral status of abortion in Chile? Do Chileans relate the topic of abortion to the theme of women’s …

Weza Motrin Pichikeche Meu: El Entendimiento Cultural De La Obesidad Infantil En El Pueblo Mapuche, Katherine Shaffer

Independent Study Project (ISP) Collection

Research Question: How do the Mapuche people interpret childhood obesity, and how do they use this interpretation to treat and prevent this disease?

Objective: To describe the Mapuche concept of childhood obesity used by families and community leaders in Makewe, Chile, and how this concept is used to treat and prevent this disease.

Background: Childhood obesity is a growing problem throughout much of the world, including Chile, with grave effects on physical and mental health. There are a plethora of causes of this disease, from individuals with an imbalance in calorie expenditure, to national and international policies in economy and …

A Comparison Of Malnutrition Causes And Treatments: A Case Of Mwanamugimu Nutrition Unit, Mulago National Referral Hospital, Kampala District And Nakifuma Government Health Unit, Mukono District, Berkley Singer

Independent Study Project (ISP) Collection

In beginning of the investigation process, the researcher set out to study malnutrition in Uganda. She wanted to study an urban region in comparison to a rural region and so based her research out of both Kampala and the Mukono region. The researcher set out to learn more about the causes of the condition and why children become malnourished. She also was interested in the differences that exist between the two different locations and why they exist. Finally, the researcher was eager to learn what malnutrition meant to each community and how health care professionals go about treating the condition …

Impact Of Social Franchising On Contraceptive Use When Complemented By Vouchers: A Quasi-Experimental Study In Rural Pakistan, Syed Khurram Azmat, Babar Tasneem Shaikh, Waqas Hameed, Ghulam Mustafa, Wajahat Hussain, Jamshaid Asghar, Muhammad Ishaque, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: Pakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society - a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in …

Mapping Disease At An Approximated Individual Level Using Aggregate Data: A Case Study Of Mapping New Hampshire Birth Defects, Xun Shi, Stephanie Miller, Kevin Mwenda, Akikazu Onda

Dartmouth Scholarship

Limited by data availability, most disease maps in the literature are for relatively large and subjectively-defined areal units, which are subject to problems associated with polygon maps. High resolution maps based on objective spatial units are needed to more precisely detect associations between disease and environmental factors. Method: We propose to use a Restricted and Controlled Monte Carlo (RCMC) process to disaggregate polygon-level location data to achieve mapping aggregate data at an approximated individual level. RCMC assigns a random point location to a polygon-level location, in which the randomization is restricted by the polygon and controlled by the background (e.g., …

"Being Stuck": Understanding The Health-Related And Everyday Lived Experiences Of Young Mothers In Rexdale, Ontario Through A Social Determinants Framework, Jaspreet Kaur

Electronic Thesis and Dissertation Repository

The purpose of this study was to gain an understanding of the ways the health-related and everyday lived experiences of young mothers are shaped by various social determinants, and in the context of their neighbourhood. Using a critical qualitative methodology, five mothers between the ages of 17 to 19 were interviewed from Rexdale, a neighbourhood in the City of Toronto characterized by a number of social risk factors(e.g. high rates of visible minorities, unemployment, and teen mothers). In-depth thematic analysis led to the emergence of four themes: 1) Living in Rexdale: Representations and realities; 2) Leaving Rexdale and wanting something …

Exploration Of Breastfeeding Concepts Among Current And Future Parents: Results Of Questionnaires Administered To Chinese And Us University Students And To New Mothers In China, Zixin Lou

Doctoral Dissertations

The objectives were to explore breastfeeding knowledge, attitudes, and intention of future parents, and to investigate indicators and causes of perceived insufficient milk (PIM) supply among Chinese mothers. Objectives were accomplished using a cross-sectional study design. Two questionnaires were developed, one targeting Chinese and US undergraduates, and a second targeting Chinese mothers. In total, 597 undergraduates (395 Chinese; 202 US) and 392 Chinese mothers participated in the study. Data cleaning resulted in a final sample size of 572 for undergraduates (383 Chinese; 189 US) and 341 for Chinese mothers. Results showed that undergraduates in both countries possessed some breastfeeding knowledge …

2012 Annual Report Of Child Deaths In Clark County, Nevada, Nevada Institute For Children’S Research And Policy, Tara Phebus

Nevada Institute for Children's Research and Policy Reports

The primary goal of all Child Death Review Teams is to prevent future child deaths. The child death review process enables jurisdictions to come together in a collaborative, multidisciplinary forum to openly discuss detailed circumstances in an effort to gain a better understanding of child deaths. The team provides a venue for representatives from a variety of both public and private agencies as well as community organizations to share information in a confidential and non-threatening environment. The National Center for Child Death Review (hereinafter, National Center), which is supported by the Maternal and Child Health Bureau of the U.S. Department …

The Relationship Between Prenatal Stress, Depression, Cortisol And Preterm Birth: A Review, Kiran Shaikh, Shahirose Premji, Khurshid Khowaja, Suzanne Tough, Ambreen Kazi, Shaneela Khowaj

School of Nursing & Midwifery

Preterm birth is one of the most common adverse pregnancy outcomes. Maternal risk factors such as stress and depression have been associated with preterm birth. Preterm infants are at a higher risk of poor growth and neuro developmental outcomes. The objective of this paper is to examine the relationship between maternal stress, depression, cortisol level, and preterm birth. Preterm birth is one of the most common adverse pregnancy outcomes with a global prevalence of 9.6% and one of the major contributors to infant mortality and morbidity. The association between psychosocial stress and preterm birth, although examined for more than 25 …

Ending Preventable Maternal Deaths: The Time Is Now, Flavia Bustreo, Lale Say, Marge Koblinsky, Thomas W. Pullum, Marleen Temmerman, Ariel Pablos-Méndez

Obstetrics and Gynaecology, East Africa

Between 1990 and 2010, maternal mortality decreased globally by nearly 50%, from 543 000 maternal deaths per year to 287 000, with the greatest reductions in the second half of this period. A major catalyst for this progress was the target set by Millennium Development Goal 5: reduction of the maternal mortality ratio by 75% between 1990 and 2015. Later, a second target on reproductive health was added, which has undoubtedly contributed to accelerated progress. In tandem, countries and the international community enhanced their commitment to support, develop, and implement effective interventions to improve the health of women, especially during …

Assessment Of Competence For Caesarean Section With Global Rating Scale, Rahat Najam Qureshi, Syeda Kauser Ali

Department for Educational Development

Objective: To establish as reliable and valid the nine-point global rating scale for assessing residents\' independent performance of Caesarean Section.

Methods: The validation study was conducted at the Department of Obstetrics and Gynaecology, Aga Khan University Hospital, from April to December 2008, and comprised 15 residents during 40 Caesarean Sections over 9 months. Independently two evaluators rated each procedure and the difficulty of each case.

Results: The observations per faculty ranged from 1-8 (mean 4.07± 2.56). The Year 4 residents were observed the most i.e. 32 (40%), followed by Year 3, 30 (37.5%); Year 2; 14 (17.5%); and Year 1, …

The Impact Of Social Integration On The Lived Experience Of Resilience Among Women Who Lived In Poverty During Childhood, Nedra R. Peter

Electronic Thesis and Dissertation Repository

This thesis is a study of the lived experience of poverty and resilience among women who lived in poverty during childhood. The aim of this study was to investigate the impact of social integration on resilience to the adverse effects of poverty. This investigation was conducted as a retrospective study. Using a hermeneutic phenomenological approach, seven women who lived in poverty during childhood were interviewed in semi-structured interviews lasting 60 to 90 minutes. These interviews, along with a member-checking meeting, were the primary method of data collection. Data was analyzed through thematic analysis informed by van Manen (1990, 1997). The …

Promoting Abstinence From Alcohol During Pregnancy: Implications From Formative Research, Kathryn France, Robert Donovan, Nadine Henley, Carol Bower, Elizabeth Elliott, Janet Payne, Heather D'Antoine, Anne Bartu

Research outputs 2013

This research developed messages to promote abstinence from alcohol during pregnancy and identified elements that enhance message persuasiveness. An exploratory phase was conducted in 2009 that comprised four focus groups with 23 women inWestern Australia and elicited beliefs and attitudes on alcohol use during pregnancy and motivations for behavior change. Four television concepts were subsequently developed and appraised in five focus groups with 31 participants using standard advertising pretesting questions. The implications for campaigns addressing prenatal alcohol exposure and further research are noted and limitations discussed. Funding was received from Healthway and the National Health and Medical Research Council.

The Association Between A Medical History Of Depression And Gestational Diabetes In A Large Multi-Ethnic Cohort In The United States, Katherine Bowers, S. Katherine Laughon, Sungduk Kim, Sunni L. Mumford, Jennifer Brite, Michele Kiely, Cuilin Zhang

Publications and Research

Background: Both major depression and gestational diabetes mellitus (GDM) are prevalent among women of reproductive age. Our objective was to determine whether a medical history of depression is related to subsequent development of GDM.

Methods: The Consortium on Safe Labor was a US retrospective cohort study of 228 562 births between 2002 and 2008. Exclusion criteria for the present analysis included multiple gestation pregnancies (n = 5059), pre-existing diabetes (n = 12 771), deliveries(n = 395), site GDM prevalence (

Results: The final analytic population included 121 260 women contributing 128 295 pregnancies, of which 5606 were affected by GDM. …

Hiv-1 Autologous Antibody Neutralization Associates With Mother To Child Transmission, Elly Baan, Anthony De Ronde, Martijn Stax, Rogier W. Sanders, Stanley Luchters, Joseph Vyankandondera, Joep M. Lange, Georgios Pollakis, William A. Paxton

Population Health, East Africa

The HIV-1 characteristics associated with mother to child transmission (MTCT) are still poorly understood and if known would indicate where intervention strategies should be targeted. In contrast to horizontally infected individuals, exposed infants possess inherited antibodies (Abs) from their mother with the potential to protect against infection. We investigated the HIV-1 gp160 envelope proteins from seven transmitting mothers (TM) whose children were infected either during gestation or soon after delivery and from four non-transmitting mothers (NTM) with similar viral loads and CD4 counts. Using pseudo-typed viruses we tested gp160 envelope glycoproteins for TZM-bl infectivity, CD4 and CCR5 interactions, DC-SIGN capture …

Review Of Ourselves Unborn: A History Of The Fetus In Modern America, By Sara Dubow, Rose Holz

Women's and Gender Studies Program: Faculty Publications

With the publication of the Bancroft Prize-winning Ourselves Unborn, Sara Dubow offers a long overdue analysis and historicization of what has become a central feature in battles over reproductive rights: the fetus. Drawing upon legal and legislative records as well as educational tracts, museum exhibits, medical textbooks and journals, personal memoirs, and the popular press, Dubow traces what she calls “fetal stories” (4) in America from the late nineteenth century through the early twenty-first. In so doing, she persuasively reminds her readers the following: First, that our understanding of the fetus is not simply a product of biology or theology. …