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Background Abortion-related complications are among the common causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first-trimester incomplete abortions but is seldom used for post-abortion care in Malawi. Methods A descriptive cross-sectional study that used mixed methods was conducted in three hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part. Results From the qualitative data, three themes emerged around the following areas: experienced effects, support offered, and women’s perceptions. Most women liked misoprostol and reported that the treatment was helpful and effective in expelling retained products of conception. Quantitative data revealed that the majority of participants, 376 (94%) were satisfied with the support received, and 361 (90.3%) believed that misoprostol was better than surgical treatment. The majority of the women 364 (91%) reported they would recommend misoprostol to friends. Conclusions The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women.

The aim of this study was to describe temporal trends in socio-demographic and lifestyle characteristics among delivering women in two Northern provinces of Russia from 1973 to 2017. Totally 161,730 births were registered in three birth registries. Changes in the distribution of maternal age, education, marital status, smoking during pregnancy were studied using Pearson's chi-squared tests and one-way ANOVA. The logistic regression models were used to assess factors, contributing to the variations in the prevalence of maternal smoking. The mean age of primiparous mothers increased from 22.1 years in 1973-1980 to 25.4 years in 2012-2017 (p 0.001). The proportion of primiparous mothers with higher education increased from 26.2% in 2006 to 38.3% in 2017 (p 0.001). The proportion of cohabiting primiparous women increased from 5.0% to 15.2% over the study period (p 0.001). The proportion of mothers smoking during pregnancy decreased from 18.9% in 2006-2011 to 14.8% in 2012-2017 (p 0.001). Downward in the prevalence of smoking was revealed in 2012-2017 compared to 2006-2011 (OR = 137.76; 95%CI:71.62-264.96, OR = 183.74; 95%CI:95.52-353.41, respectively). Over the past decades, women postpone childbearing until receiving higher education, continue living in cohabitation during pregnancy and smoke less.

ObjectivesThe study was conducted to determine effectiveness of a training intervention in increasing use of misoprostol in management of incomplete abortions.DesignA quasi-experimental study with training intervention on use of misoprostol in treatment of incomplete abortion.SettingFive secondary-level public hospitals in Malawi, one in urban and four in semiurban settings. Three intervention and two control sites.ParticipantsRecords of women treated for first-trimester incomplete abortion from March to May 2020 (baseline) and April to June 2021 (endline). Clinical data were collected from 865 records, 421 before and 444 after the intervention in all study sites.InterventionThree-hour theoretical training sessions for 81 healthcare workers were conducted in July 2020 at the three intervention sites.Primary and secondary outcome measuresProportion of women with incomplete abortion treated with misoprostol before and after the intervention. The proportion of women treated with sharp curettage at the study sites.ResultsAt the intervention sites, there was a significant increase in use of misoprostol from 22.8% (95% CI 17.9% to 28.0%) to 35.9% (95% CI 30.5% to 41.6%) and significant reduction in use of sharp curettage from 48.1% (95% CI 41.9% to 54.3%) to 39.4% (95% CI 35.3% to 42.6%) pConclusionsA training intervention effectively increased the use of misoprostol in the treatment of incomplete abortions. Increasing misoprostol use will make treatment of incomplete abortion cheaper, easier and more easily accessible. Making quality postabortion care accessible to more women may reduce maternal morbidity and mortality. Further training interventions are recommended.

Postpartum depression (PPD) is a form of non-psychotic disorder that develops after childbirth with negative consequences for physiological, social and psychological development of the children. The global prevalence of PPD today equals approximately 17.22%. However, almost one half of all cases remain undetected. Healthcare providers can help to reduce the prevalence of PPD by identifying and educating women about the risks and treatment of PPD. The review is the first Russian-language study of systematic selection and qualitative synthesis of the studies in the field of nursing staff knowledge about PPD published from January 2000 to November 2020. The search was conducted in such eligible databases as MEDLINE, PsychINFO, EMBASE, Cinahl, eLIBRARY using the keywords “postpartum depression”, “knowledge”, “detection of postpartum depression”. As a result of the search, it was revealed that knowledge on postpartum depression was superficial in over one half of the midwives and nurses participating in the reviewed studies (n=1777). This result indicates the need to develop and implement training programmes for prevention of postpartum depression among medical personnel. The small amount of unique results underlines the need for further research on the knowledge of postpartum depression among midwives and nurses

Background Abortion related complications are among the leading causes of maternal mortality in Malawi. Misoprostol is recommended for the treatment of first trimester incomplete abortions but is seldom used for post abortion care in Malawi. Methods A descriptive cross-sectional study that used mixed methods was conducted in 3 hospitals in central Malawi. A survey was done on 400 women and in-depth interviews with 24 women receiving misoprostol for incomplete abortion. Convenience and purposive sampling methods were used and data were analysed using STATA 16.0 for quantitative part and thematic analysis for qualitative part. Results Data are presented in tables and narratives, three themes emerged around the following areas: experienced effects, support offered, and women’s perceptions. Almost all participants reported having received drugs and counselling as support from health care workers. The majority of participants, 94%, reported satisfaction with the support and described misoprostol as helpful and effective in expelling retained products of conception. Misoprostol was preferred and regarded as the most reliable treatment and beneficial to women by most participants. The majority of the women reported tolerable effects of the drug and 91% would recommend misoprostol to friends. Conclusions The use of misoprostol for incomplete abortion in Malawi is acceptable and regarded as helpful and satisfactory among women. Trial registration: Not applicable

Maternal and neonatal mortality has remained a public health challenge in developing countries, particularly in Zambia despite the efforts to improve access and use of maternal health care services universally. Majority of these maternal deaths could be prevented by ensuring access to good-quality maternal health services, such as antenatal and postnatal care, and skilled attendance during child birth, including emergency obstetric care. This study explored the perspectives of midwives on factors influencing maternal morbidity and mortality rates in Zambia. A qualitative approach was utilized for this study to identify the experiences as described by the participants. This study was carried out in Lusaka urban and Mumbwa rural districts. Focus groups discussions were utilized to collect data. The challenges in the provision of care was understaffing and lack of infrastructure, fear of HIV test, attitude of the midwives, trusting herbal medicines, poverty, congestion at the hospitals and distance to health care facilities were mentioned as underlining causes of maternal morbidity and mortality. Equipping midwives with supplies and required equipment in antenatal and postnatal areas may help alleviate the challenges midwives face in the delivery of care Key words: Midwifery, midwives, midwives perspectives, maternal morbidity, mortality.

To describe the features of HIV-associated chronic lung disease (CLD) in older children and adolescents living with HIV and to examine the clinical factors associated with CLD. This is a post hoc analysis of baseline data from the BREATHE clinical trial (ClinicalTrials.gov, NCT02426112).Children and adolescents aged 6-19 years were screened for CLD (defined as a FEV1 z-score-1 with no reversibility post-bronchodilation with salbutamol) at two HIV clinics in Harare, Zimbabwe, and Blantyre, Malawi. Eligible participants with CLD (cases) were enrolled, together with a control group without CLD [frequency-matched by age group and duration on antiretroviral therapy (ART)] in a 4:1 allocation ratio. A clinical history and examination were undertaken. The association between CLD and a priori-defined demographic and clinical covariates was investigated using multivariable logistic regression.Of the 1585 participants screened, 419 (32%) had a FEV1 z-score-1, of whom 347 were enrolled as cases [median age 15.3 years (IQR 12.7-17.7); 48.9% female] and 74 with FEV1 z-score0 as controls [median age 15.6 years (IQR 12.1-18.2); 62.2% female]. Among cases, current respiratory symptoms including cough and shortness of breath were reported infrequently (9.3% and 1.8%, respectively). However, 152 (43.8%) of cases had a respiratory rate above the 90th centile for their age. Wasting and taking second-line ART were independently associated with CLD.The presence of CLD indicates the need to address additional treatment support for youth living with HIV, alongside ART provision, to ensure a healthier adulthood.Décrire les caractéristiques de la maladie pulmonaire chronique (MPC) associée au VIH chez les enfants plus âgés et les adolescents vivant avec le VIH et examiner les facteurs cliniques associés à la MPC. Il s'agit d'une analyse post-hoc des données de référence de l'essai clinique BREATHE (ClinicalTrials.gov, NCT02426112 ). MÉTHODES: Les enfants et adolescents âgés de 6 à 19 ans ont été dépistés pour la MPC (défini comme un score z FEV1-1 sans réversibilité post-bronchodilatation avec du salbutamol) dans deux cliniques VIH à Harare, au Zimbabwe et à Blantyre, au Malawi. Les participants éligibles atteints de MPC (cas) ont été inscrits, ainsi qu'un groupe témoin sans MPC (fréquence appariée par groupe d'âge et durée sous ART) dans un rapport d'allocation de 4:1. Une histoire clinique et un examen ont été entrepris. L'association entre la MPC et les covariables démographiques et cliniques définies a priori a été étudiée en utilisant une régression logistique multivariable. RÉSULTATS: Sur les 1.585 participants dépistés, 419 (32%) avaient un score z FEV 1-1, dont 347 étaient inscrits comme cas (âge médian 15,3 ans [IQR 12,7 -17,7]; 48,9% de sexe féminin), et 74 avec un score z FEV10 comme témoins (âge médian 15,6 ans [IQR 12,1 -18,2]; 62,2% de sexe féminin). Parmi les cas, les symptômes respiratoires en cours, y compris la toux et l'essoufflement, n’ont pas été rapportés fréquemment (9,3% et 1,8%, respectivement). Cependant, 152 (43,8%) des cas avaient une fréquence respiratoire supérieure au 90La présence de MPC indique la nécessité d’un soutien thérapeutique supplémentaire aux jeunes vivant avec le VIH, à côté de à la fourniture de l’ART, pour assurer un âge adulte en meilleure santé.

Poor use of fistula repair services has contributed to the continued consequences of obstetric fistula that are physical, psychological, social, financial and economic among the afflicted women. The study was designed to assess views of health care providers on factors hindering women with obstetric fistula in seeking fistula repair services. A descriptive cross sectional design was used. Sixty-five (65) health care providers were selected through convenient sampling method to participate in the study. A structured interview schedule was used to collect data. Reliability was ensured using test retest and alpha value of 0.7 for the views scale Statistical analysis was performed with the IBM SPSS Statistics 20 software. Data was expressed as descriptive summary measures. Factors found to be hindering women in seeking fistula repair services were lack of knowledge that repair services exist, anxiety, loss of dignity, stigma, transportation challenges, financing for the procedure, myths and misconception on obstetric fistula and health systems barriers. Therefore, there is need to engage the individual, communities, organisations and policy makers in order to improve women’s use of fistula repair services. Key words: Health care providers, women with obstetric fistula, fistula repair services, obstetric fistula, Views, Zambia.

Background/Aims Obstetric fistula is a serious birthing injury with medicosocial consequences including infertility and marital disharmony. Obstetric fistula has been eliminated in developed countries but remains highly prevalent in Africa and Asia. The aim of this study was to identify and analyse the marital experiences of women with obstetric fistula in order to guide interventions to help women cope with their situation, as well as improving partner support towards women living with this condition. Methods A range of electronic databases were searched for studies conducted worldwide, published between 2003 and 2018. English language publications were searched for using relevant keywords. Three main themes were identified based on the content of the interview questions and the respondents' views and experiences, and how these related to the study objectives. Results A total of 33 studies were included. Three main themes in the marital experiences of women with obstetric fistulas were identified: ‘loss of marriage’ (n=25), ‘marital and sexual life is no longer joyful’ (n=17), and ‘partner support’ (n=22). Conclusions Obstetric fistula can have significant impacts on a woman and her partner. Healthcare professionals should be aware of these concerns and surgical repair should be encouraged. Counselling should be provided for women with obstetric fistula and their partners.

The aim of the study was to explore the personality of women with different smoking behavior during pregnancy using a biopsychosocial approach. Women aged 18-38 years who were hospitalized in the maternity hospitals of Arkhangelsk were enrolled to the study. Pregnant women were divided into three groups depending on the tobacco history: “smokers”, “quitters” and “non-smokers”. As a result of the study, we determined variation in social, biological and psychological components of the personality of women with different smoking behavior during pregnancy. Thus, quitting smoking during pregnancy was more common in married women, and those who had a non-smoking father of the child. Women who stopped smoking during first trimester in compared to smokers were more introverted, had more frequently an instinct of “self-preservation” and “research”. Values of euphoric type of psychological component of gestational dominant and self-esteem were higher among women who stopped smoking during pregnancy in compared to smokers. Smokers in compared to non-smokers had a lower social and economic status, were more often extroverted, emotionally unstable, rigid, less often had a strong development of the instinct «procreation», «research», «altruism», but more often «liberty». Moreover, smokers showed higher rates of depressive, anxious of psychological component of gestational dominant and weaker development of self-esteem and will. So, the revealed features demonstrate those targets to which preventive measures should be directed.

Background A high prevalence of cardiac abnormalities has been reported in children with human immunodeficiency virus (HIV) taking antiretroviral therapy (ART) in sub-Saharan Africa. We investigated the incidence and progression of cardiac abnormalities among children taking ART in Zimbabwe. Methods A prospective cohort study was conducted at a pediatric HIV clinic from 2014 to 2017. Children with HIV aged between 6 and 16 years and taking ART ≥6 months were enrolled. Transthoracic echocardiography was performed at baseline and after 18 months. Results Of 197 participants recruited at baseline, 175 (89%; 48% female; median age 12 years, interquartile range 10–14 years) were followed up. The incidences of left and right heart abnormalities were 3.52 and 5.64 per 100 person-years, respectively. Stunting was associated with the development of any cardiac abnormality (adjusted odds ratio 2.59, 95% confidence interval 1.03–6.49; P = .043). Right ventricular (RV) dilatation persisted at follow-up in 92% of participants and left ventricular (LV) diastolic dysfunction in 88%. Cardiac abnormalities present at baseline reverted to normal over the follow-up period in 11 (6%). There was an overall increase in mean z scores for LV, left atrium (LA), RV, interventricular septum, and LV posterior wall diameters at 18 months (P < .001). Conclusions Despite ART, children with HIV have a high incidence of cardiac abnormalities, with only a minority being transient. Mean z scores for LV, LA, RV, interventricular septum, and LV posterior wall diameters increased over a relatively short follow-up period, suggesting the potential for progression of cardiac abnormalities. Longer follow-up is required to understand the clinical implications of these abnormalities., Older children and adolescents with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy in sub-Saharan Africa have a high incidence of echocardiographic abnormalities, which are likely primary HIV-related heart muscle disease and have the potential for progression over time.

Complications after abortion are a major cause of maternal death. Incomplete abortions are common and require treatment with surgical or medical uterine evacuation. Even though misoprostol is a cheaper and safer option, it is rarely used in Malawi. To improve services, an intervention was performed to increase the use of misoprostol in post-abortion care. This study explored healthcare providers’ perceptions and experiences with misoprostol in the Malawian setting and their role in achieving effective implementation of the drug. A descriptive phenomenological study was conducted in three hospitals in central Malawi. Focus group discussions were conducted with healthcare workers in centres where the training intervention was offered. Participants were purposefully sampled, and thematic analysis was done. Most of the healthcare workers were positive about the use of misoprostol, knew how to use it and were confident in doing so. The staff preferred misoprostol to surgical treatment because it was perceived safe, effective, easy to use, cost-effective, had few complications, decreased hospital congestion, reduced workload, and saved time. Additionally, misoprostol was administered by nurses/midwives, and not just physicians, thus enhancing task-shifting. The results showed acceptability of misoprostol in post-abortion care among healthcare workers in central Malawi, and further implementation of the drug is recommended.

Selenium (Se) is an essential trace element and its deficiency in utero may affect fetus development and birth outcomes. The current study aimed to assess serum Se status at delivery and examine the possible association between Se levels and birth outcomes. The interaction of Se with selected essential and toxic elements as well as possible sex-dependent responses in utero were also evaluated. The negative association between Se levels and head circumference of neonates was evident in the total cohort (β = −0.164, p &lt, 0.001) as well as in the pre-term and full-term cohorts. Significant positive correlations were found between maternal serum Se concentrations and zinc (Zn) and copper (Cu) in the total and regional cohorts. In the total cohort, the toxic elements lead (Pb) and arsenic (As) showed a negative correlation with Se levels, while mercury (Hg), aluminum (Al) and cadmium (Cd) showed a positive correlation. The study found a sex-dependent response in utero for Zn, Cu, Pb, Hg, and Al. The findings of the current study may inform reproductive health policy on Se status in South Africa and highlight the need for sensitive methods to measure Se intake during pregnancy and its complex interactions with other micronutrients and environmental pollutants.

Deleterious effect of cold on overall mortality is well-established. We studied associations between the air temperature and the number f ambulance calls for asthma in Nur-Sultan, Kazakhstan – the second coldest capital in the world. Daily counts of ambulance calls for asthma in Nur-Sultan for the cold seasons (October-March) 2006–2010 were obtained from the Municipal Ambulance Station. Associations between the number of calls and mean and minimum apparent temperatures (average for lags 0–15) were studied using first-order Poisson auto-regression models controlling for wind speed and effects of month, year, weekends and holidays. Altogether, there were 7373 ambulance calls for asthma during the study period. An inverse association between minimum apparent temperature and the number of calls was observed for the age-group 60 years and older. A decrease of the minimum apparent temperature by 1°C was associated with an increase in the number of calls by 1.7% (95% CI: 0.1%-3.3%) across the whole temperature spectrum. No associations in other age groups were found. Our results suggest an inverse association between the average 15-day lag minimum apparent temperature and the number of ambulance calls during the cold season in Nur-Sultan, but this is limited to the oldest age-group.

To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level. publishedVersion

In the Russian Arctic, alarming trends (shortage of nomadic Indigenous women, high reproductive loss, child mortality rates) indicate long-term changes towards demographic decline. This study aimed at comparing some indicators of the reproductive health (childbirth rates, number of pregnancies, pregnancy loss) of Indigenous and non-Indigenous women in the exploration of cultural and social factors influencing reproductive behaviour. A multidisciplinary approach draws on methods of medicine, sociology and health economics. It includes data of the women’s reproductive health collected from surveys of 879 women (of whom 627 were Indigenous) during expeditions to the settlements and the tundra of the Yamal-Nenets Autonomous Okrug in 2013–2019. In the tundra, 66.7% of registered Indigenous women’s pregnancies resulted in childbirth, 7.8% in induced abortions, 25.5% in spontaneous miscarriage. More than three children were delivered by 59.1% of Indigenous women. Most Indigenous families suffered from high pregnancy loss. Marriage between close relatives was 27.0%. Child mortality equalled 24.4%, three times higher than in the population of the settlements and eight times higher than in families immigrating from other regions. The survival of Indigenous peoples significantly depends on women’s reproductive health and sufficient medical service that requires targeted policy.

In a cross-sectional study of 296 children and adolescents from Zimbabwe living with perinatal human immunodeficiency virus, individuals with the top tertile of cytomegalovirus-specific immunoglobulin G titer had an increased odds of chronic lung disease (odds ratio, 3.33; 95% confidence interval, 1.37–8.85; P = .010).

The most vulnerable period in a human life is before you are born and in early childhood. A number of reports and publications are now coming out of these studies and this chapter will go into details of some of the the most important studies and their defined health endpoints. Different epidemiological studies in the circumpolar area have shown associations between contaminants and different health outcomes. It is important to note that associations are not the same as causal relationships between exposure to a single substance (or a mix of substances) and an effect. When finding an association between a contaminant and an effect it is important to bear in mind the possibility that the studied substance are proxies for other substances in the mixture of contaminants to which the study population has been exposed – both harmful and beneficial. The effects reported are findings from different circumpolar communities. However, due to differences in genetic composition, socio-cultural practices, local food consumption patterns and exposure mixtures, a finding in one population should not be extrapolated to another population without careful investigation and comparative information.

Background Pregnancy outcomes are widely used indicators of population wellbeing varying both between and within countries. The aim of this study was to assess social variations in preterm births and term small-for-gestation-age (SGA) infants in the Northernmost provinces of Europe - the Murmansk region - using the data from the first Russian population-based birth registry. Methods A registry-based study of 52 806 births in the Murmansk region for a 5-year period was performed. We studied the prevalence and social determinants of moderate-to-late preterm births (MLPTB, 224-258 days of gestation), very preterm births (VPTB, 196-223 days) and extremely preterm births (EPTB, 154-195 days) and term SGA for both weight and length births (SGAWL). Associations between social factors and pregnancy outcomes were studied by multivariable logistic regression. Results The prevalence of PTB was 6.9 with EPTB, VPTB and MLPTB constituting 0.3%, 0.6% and 6.0%, respectively. A total of 4.1% of infants were SGAWL. Women with primary, secondary and vocational education were 1.59 (95%CI:1.22-1.85), 1.33 (95%CI:1.20-1.48), 1.19 (95%CI:1.22-1.85) times more likely to have MLPTB than women with higher education. Corresponding values for VPTB were 1.65 (95%CI:0.88-3.08), 1.41 (95%CI:1.02-1.95) and 1.27 (95%CI:0.92-1.75), respectively. Single and cohabiting women had significantly elevated risk for MLPTB (ORs=1.47 (95%CI:1.30-1.66) and 1.39 (95%CI:1.26-1.44)) and VLPTB (ORs=2.00, 95% CI: 1.42-2.81 and 1.32, 95% CI: 0.97-1.79) compared to married women. Unmarried mothers were more likely to have SGAWL boys (OR = 1.60, 95% CI: 1.38-1.86) and SGAWL girls (OR = 1.51, 95%CI:1.31-1.76) compared to married women. Conclusions We observed significant social variations in pregnancy outcomes by maternal education and marital status in the Murmansk region. Registry data can be used as an effective tool for monitoring inequalities in pregnancy outcomes as indicators of social inequalities. Key messages We found significant social variations in pregnancy outcomes in the Northernmost province of Europe - the Murmansk county (Russia). Birth registry data can be used for monitoring of health inequalities in Russia.

Background Tobacco smoking is a public health problem. Even though this habit is less common among women than men in Russia, it appears to be on the increase among women aged ≥15 years. Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on maternal smoking and birth weight, the influence of stop smoking on low birth weight is not well documented. The aim of the study was to assess an effect of quitting smoking during the first trimester on low birth weight. Methods The study is based on the Murmansk County Birth registry. Women who delivered a singleton pregnancy after 37 weeks of gestation were comprised to the study (N = 44,486). Smoking information was assessed at the first antenatal visit during pregnancy and self-reported and. Low birth weight was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions, we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain. Results The prevalence of low birth weight was 1.1%. This adverse birth outcome was more prevalent in women who smoked during pregnancy (2.5%) in compared to those who stopped do it during pregnancy (0.8%) or did not smoke before and during pregnancy (0.9%) (p Conclusions We observed that women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy. Key messages Women who stop smoking during the first trimester are at no greater risk of having a term baby with low birth weight. Our findings underline a continued need for actions against smoking during pregnancy.

Introduction Periconceptional use of folic acid supplementation is an evidence-based measure of birth defects prevention. The study was aimed to assess effect of periconceptual use of folic acid on birth defect prevalence in Arkhangelsk county and to investigate socio-demographic factors, which are associated with adherence to this preventive measure. Methods A registry-based study was conducted with data from the Arkhangelsk County Birth Registry for 2012-2015. The study population included 57084 pregnancies to calculate the proportion of women taking folic acid and 53340 pregnancy outcomes without missing data to analyze related socio-demographic characteristics. Results The proportion of women followed a folic acid supplementation before pregnancy was 1.3% (95% CI: 1.2-1.4), during pregnancy - 55.8% (95%CI: 54.6-56.4). Such women had less risk to deliver a newborn with any birth defects (OR = 0,84, 95%CI: 0,75 - 0,95). Considering birth defects prevalence of 38,6 per 1000 newborns in Arkhangelsk county, number needed to prevent one case of birth defect was 142,9. Based on multivariate analysis, nulliparous married women with higher education, aged 30 or more, had a higher chance to use folic acid before and during pregnancy. The history of spontaneous abortion in the mother's medical history and the first pregnancy were negatively associated with the probability of folic acid intake both before and during pregnancy. Conclusions The compliance to periconceptional intake of folic acid among women in the region was low. A level of compliance was associated with such socio-demographic factors as age, education, marital status, gravidity and parity. The findings have direct applications in improving prenatal care in Arkhangelsk county and establishing targets for prenatal counseling. Key messages A level of compliance to primary prevention of birth defects is associated with such socio-demographic factors as age, education, marital status, gravidity and parity. Prenatal counseling in terms of birth defects prevention should be based on socio-demographic characteristics of pregnant women.

A Norwegian-Russian cooperation in public health education in the Euro-Arctic Barents region started in the 1980s. In the 1990s it has been mostly limited to research- and student exchanges. In September 2006 seven universities including Northern State Medical University, Arkhangelsk (Russia), University of Tromsø (Norway), Nordic School of Public Health (Sweden), Umeå University (Sweden), Mid-Sweden University (Sundsvall, Sweden), Tampere University (Finland) and the National Institute of Public Health (Oslo, Norway), came together to found the International school of public health in Arkhangelsk, Russia (ISPHA). The mission of the ISPHA was to increase the level of knowledge in methods of research and practice in the field of public health, and to promote the implementation of this knowledge in Northwest Russia. Since 2007, ISPHA is providing public health education based on a 2-year MPH training. In 2007, ISPHA became the first full member of ASPHER. Forty-eight specialists got MPH degrees at ISPHA as a part of the program. In 2013 a PhD programme between NSMU and the University of Tromsø was established. In 2013-19, 6 PhD theses were defended, and totally 28 full-text papers were published in peer-reviewed journals. In 2017 two new PhD programs in public health between Norway and Russia were initiated. The programme in environmental health and registry epidemiology in Arctic and Sub-Arctic Russia is run in collaboration between two Russian and two Norwegian universities while the second programme on cardiovascular epidemiology is run by NSMU and the University of Tromsø. Both programmes have already recruited PhD students and teachers from both countries. Achievements, challenges, sustainability and future perspectives will be discussed. In spite of political perturbations, cooperation in public health education and research between Norway and Russia is contributing to better understanding of each other and strengthening public health workforce in Arctic Russia. Key messages Norwegian Russian cooperation evolved from exchanges to PhD programs. Most of the graduates strengthen public health capacity in their regions.

Short-, medium-, and long-chain chlorinated paraffins (SCCPs, MCCPs, and LCCPs) were analyzed in human milk from the Yangtze River Delta (YRD) and Scandinavia. Individual samples were collected from Shanghai, Jiaxing, and Shaoxing (China), Stockholm (Sweden), and Bodø (Norway) between 2010 and 2016. Mean concentrations (range) of SCCPs, MCCPs, and LCCPs in samples from the YRD were 124 [

The overwhelming majority of Arctic biomonitoring studies in humans include either pregnant or non-pregnant women of reproductive age while little attention is paid to toxic compounds concentrations in men. This study contributes with information of the present amounts of persistent organic pollutants (POPs) in men living in Arctic Russia. We studied the serum concentrations of 11 polychlorinated biphenyl (PCB) congeners and 17 organochlorine pesticides (OCPs) and some of their metabolites in samples collected from 92 adult men (mean age 43 years) from seven different settlements in Nenets Autonomous Okrug (NAO). The median concentrations of individual PCB congeners increased in the order PCB 183, PCB 180, PCB 118, PCB 138, PCB 153. The concentrations of o, p′-DDD, p, p′-DDD, aldrin, mirex and 1,2,3,5-TCB were in most cases below the quantification limit. The observed concentrations of PCBs and chlorinated pesticides were in the same range as those found in similar groups of women of these territories, but lower than of men in other Arctic countries. However, significant geographic differences between the settlements were observed with exceptionally high concentrations of PCBs in the Islands group. The highest serum ∑PCBs and β-HCH levels were observed in adult males aged 60–78 years. We found significant variations in serum concentrations of POPs across settlements and ethnic groups with exceptionally high concentrations of PCBs among the residents of the Arctic islands. At the same time, our findings suggest a considerable decrease in serum concentration of POPs over the last decade Geographic and Ethnic Variations in Serum Concentrations of Legacy Persistent Organic Pollutants among Men in the Nenets Autonomous Okrug, Arctic Russia

Te aim of the study was to explore the prevalence of quitting smoking during pregnancy and to determine factors associated with the latter. We used data from Murmansk County Birth registry from 2006 to 2011. Chi-squared tests and logistic regression were applied. We found that one-fourth smoking before pregnancy woman stopped to do it afer pregnancy recognition. Moreover, we made a social portrait of women who could quit smoking during pregnancy — urban, married women, with higher level of education, and without children (that is primiparous).

Polychlorinated biphenyls (PCBs) can be used as chemical sentinels for the assessment of anthropogenic influences on Arctic environmental change. We present an overview of studies on PCBs in the Arctic and combine these with the findings from ArcRisk—a major European Union-funded project aimed at examining the effects of climate change on the transport of contaminants to and their behaviour of in the Arctic—to provide a case study on the behaviour and impact of PCBs over time in the Arctic. PCBs in the Arctic have shown declining trends in the environment over the last few decades. Atmospheric long-range transport from secondary and primary sources is the major input of PCBs to the Arctic region. Modelling of the atmospheric PCB composition and behaviour showed some increases in environmental concentrations in a warmer Arctic, but the general decline in PCB levels is still the most prominent feature. ‘Within-Arctic’ processing of PCBs will be affected by climate change-related processes such as changing wet deposition. These in turn will influence biological exposure and uptake of PCBs. The pan-Arctic rivers draining large Arctic/sub-Arctic catchments provide a significant source of PCBs to the Arctic Ocean, although changes in hydrology/sediment transport combined with a changing marine environment remain areas of uncertainty with regard to PCB fate. Indirect effects of climate change on human exposure, such as a changing diet will influence and possibly reduce PCB exposure for indigenous peoples. Body burdens of PCBs have declined since the 1980s and are predicted to decline further., Environmental Science and Pollution Research, ISSN:0944-1344, ISSN:1614-7499

Background - In the BREATHE trial weekly azithromycin decreased the rate of acute respiratory exacerbations (AREs) compared to placebo among children and adolescents with HIV-associated chronic lung disease (CLD) taking antiretroviral therapy (ART). The aim of this analysis was to identify risk factors associated with AREs and mediators of the effect of azithromycin on AREs. Methods - The primary outcome of this analysis was the rate of AREs by study arm up to 49 weeks. We analysed rates using Poisson regression with random intercepts. Interaction terms were fitted for potential effect modifiers. Participants were recruited from Zimbabwe and Malawi between15 June 2016 and 4 September 2018. Findings - We analysed data from 345 participants (171 allocated to azithromycin and 174 allocated to placebo). Rates of AREs were higher among those with an abnormally high respiratory rate at baseline (adjusted rate ratio (aRR) 2.08 95% CI 1.10-3.95 p-value 0.02) and among those with a CD4 cell count -2 and participants without baseline resistance to azithromycin. However, there was no statistical evidence for interaction due to low statistical power. Interpretation - These may represent subgroups who may benefit the most from treatment with weekly azithromycin, which could help guide targeted treatment. Funding - There was no funding source for this post hoc analysis.

Generalization of the results of environmental hygienic studies of pollution by persistent toxic substances (PTS) of Arctic environment, levels and dynamics of exposure to PTS and PTS health effects for residents of Arctic countries (Canada, Denmark/Greenland/Faroe Islands, USA, Iceland, Finland, Sweden, Norway and Russia) within the framework of the recently published "Human Health in the Arctic - 2015" Report of the international Arctic Monitoring and Assessment Program (AMAP) have been conducted. The chronology of the previous AMAP reports on Arctic Pollution and Human Health 1998-2009 is presented; the algorithm of the introduction and development of international system for evaluation of quality assessment / quality control of laboratory measurements (AMAP ring-test) is described, along with the completed and ongoing studies in circumpolar countries (projects, cohorts, objects, scopes, dates), levels of PTS in the blood of the surveyed contingents with the geographical comparisons between the circumpolar and non-Arctic countries, incl. long-term dynamics. Adverse health effects associated with exposure to PTS of Arctic residents: neurobehavioral, immunological, cardiovascular, reproductive, endocrine, diabetogenic, carcinogenic - are analyzed; genetic/epigenetic aspects and effect modifiers are briefly considered. Short recommendations for future scientific research and management decisions in the Arctic are formulated, including the need to continue the biomonitoring of PTS (biota and human biological media), the need to develop adaptation strategies and adequate approaches to risk communication, application of the precautionary principle for "new" POPs, taking into consideration the global and regional consequences of climate change and the emergence on this background of the additional health risks for Arctic residents.

Until now, national percentiles and curves for twins based on population registry data have not been published. It complicates the diagnosis of fetal growth retardation. In the article, the algorithms of birth weight, length and head circumference percentiles and curves for twins born alive at gestational age 32-40 weeks are described. We used data from the population-based Murmansk County Birth Registry (2006-2011) and the Arkhangelsk County Birth Registry (2012-2014), Russian Federation. Data on 1 567, 1 631 и 1 628 newborns were used to create birth weight, length and head circumference percentiles, respectively. Gestational-specific curves present data on 10th, 50th and 90th percentiles. Mean birth weight and head circumference in males were higher compared to corresponding parameters in females at any gestational age. At 32 weeks of pregnancy mean birth length in females was higher compared to length in males. In our current study, the database was comprehensive enough to be representative for the population. Conclusively, the results of the study will be valuable for clinical practice across other regions of the Russian federation.

The article presents a short review of already established birth registries worldwide and their value for public health and perinatal medicine. Implementation of Arkhangelsk County Birth Registry (ACBR) is presented in detail. Paper registration form contains information on maternal pre-pregnancy and pregnancy health status, reproductive history, data on folic acid and multivitamin intake as well as alcohol consumption and tobacco smoking before and during pregnancy. Pregnancy outcomes with data on babies' anthropometry and Apgar score are also recorded. For sick liveborn infants, diagnosis and provided treatment are specified. Practical issues of ACBR implementation including the process of transferring data from registration paper forms to computer database are described. From January 1, 2012 to December 31, 2014, 43 327 births were recorded in the ACBR. It comprises 99.6 % of all stillborn and liveborn infants with gestational age 22 and more weeks born in Arkhangelsk County in 2012-2014. Four hundred ninety four births (1.1 %) are multiple. In 2013 and 2014, quality controls demonstrated that 97.3% records in computer database are identical to data in paper registration forms. Ethical and legal issues are discussed. All records in the ACBR are depersonalized. Some practical issues as well as future perspectives of the ACBR for cohort and cross-sectional studies in a field of perinatal epidemiology are also discussed.

It is known that medical birth registries are valuable sources of information on birth defects. They are widely used for their monitoring and control. Currently, the medical birth registries which are established in Murmansk County allow to study the birth prevalence of birth defects and trends in prevalence since 1973, including the period of socio-economic transformations and changes in medical practice caused by introduction of prenatal screening. The aim of this study was to demonstrate the effectiveness of using existing medical birth registries in Murmansk County for the surveillance of birth defects and detecting their risk factors. We found, that medical birth registries in Murmansk County can be successfully used for monitoring and control of the prevalence of birth defects as well as for epidemiological investigations because of full coverage of population and prospective collection of data on both an outcome and a prenatal condition.

Background Smoking during pregnancy leads to adverse pregnancy and birth outcomes. Compared to the number of studies on low birth weight, the influence of maternal smoking on low head circumference at birth is not well documented. The aim of the study was to assess an effect of smoking behavior before and during pregnancy on low head circumference at birth. Methods The study is based on the Murmansk County Birth registry. Our study includes women who delivered a singleton pregnancy after 37 weeks of gestation (N = 44,486). Smoking information was self-reported and assessed at the first antenatal visit during pregnancy. Low head circumference was defined in according to the World Health Organization as Mean value minus 2 standard deviations for girls and boys separately. Using logistic regressions we adjusted for maternal age, residence, ethnicity, education, marital status, alcohol abuse, year of delivery, body mass index, pregnancy diabetes, gestational age, and excessive weight gain. Results A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth (adjusted OR1-5 cig/day = 1.69 with 95% CI: 1.31-2.19; OR6-10 cig/day = 2.08 with 95% CI: 1.63-2.65; and OR ≥ 11 cig/day = 5.19 with 95% CI: 3.89-6.92). Compared to non-smokers, quitting smoking during the first trimester of pregnancy had no significant effect on low head circumference at birth (adjusted ORquitters = 1.04 with 95% CI: 0.80-1.34). Conclusions Despite dose-response relationship was observed between maternal smoking and low head circumference at birth, women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. Our findings underline a continued need for actions against maternal smoking. Key messages women who stopped smoking during the first trimester were at no higher risk of having a baby with the low head circumference as compared to non-smokers. A dose-response relationship was evident between the number of cigarettes smoked per day during pregnancy and the odds of low head circumference at birth.

Waardenburg syndrome (WS) is an orphan genetic disease with autosomal dominant pattern of inheritance characterised by varying degrees of hearing loss accompanied by skin, hair and iris pigmentation abnormalities. Four types of WS differing in phenotypic characteristics are now described. We performed a Sanger sequencing of coding regions of genes PAX3, MITF, SOX10 and SNAI2 in the patient with WS from a Yakut family living in the Sakha Republic. No changes were found in the PAX3, SOX10 and SNAI2 coding regions while a previously reported heterozygous transition c.772C>T (p.Arg259*) in exon 8 of the MITF gene was found in this patient. This patient presents rare phenotype of WS type 2: congenital unilateral hearing loss, unilateral heterochromia of irises, and absence of skin/hair depigmentation and dystopia canthorum. Audiological variability in WS type 2, caused by the c.772C>T (p.Arg259*) variant in the MITF gene, outlines the importance of molecular analysis and careful genotype–phenotype comparisons in order to optimally inform patients about the risk of hearing loss. The results of this study confirm the association of pathogenic variants in the MITF gene with WS type 2 and expanded data on the variability of audiological features of the WS.

Background The importance of blood lipids in the pathogenesis of sudden sensorineural hearing loss (SSNHL) is widely discussed in the literature. However, the published results that hyperlipidaemia causes hearing problems are contradictory. The objective of this study was to establish whether increased lipid levels affect the risk of idiopathic SSNHL. Methods A case-controlled study was conducted of 27 patients with idiopathic SSNHL and 24 healthy control subjects. All of the subjects underwent complete audiological examination. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo) A-I, apoB and apoE were measured with commercially available kits (Chronolab Systems, Spain). Several clinical ratios and indices of lipid metabolism were calculated. Results Detailed analysis of lipid metabolism in patients with idiopathic SSNHL has shown that disturbances in auditory function are associated with increased atherogenicity of the lipid profile. However, there were no significant differences in the conventional parameters of lipid metabolism (TC, TG and HDL-C) between patients with idiopathic SSNHL and subjects in the control group. Higher values of the apoB/apoA-I ratio, atherogenic index of plasma (AIP) and atherogenic index (ATH index) in patients with SSNHL indicated increased atherogenicity of the lipid profile. Binary logistic regression analysis showed that of these three indices, only higher values of the ATH index were significantly associated with an increased risk of idiopathic SSNHL. Conclusions The ATH index can be used as a marker indicating the risk of idiopathic SSNHL when the conventional lipid indices are still normal. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

BACKGROUND Congenital anomalies of the kidney and the urinary tract (CAKUTs) are relatively common birth defects. The combined prevalence in Europe was 3.3 per 1000 in 2012. The risk factors for these anomalies are not clearly identified. The aims of our study were to calculate the birth prevalences of urinary malformations in Murmansk County during 2006 to 2011 and to investigate related prenatal risk factors. METHODS The Murmansk County Birth Registry was the primary source of information and our study included 50,936 singletons in the examination of structure, prevalence and proportional distribution of CAKUTs. The multivariate analyses of risk factors involved 39,322 newborns. RESULTS The prevalence of CAKUTs was 4.0 per 1000 newborns (95% confidence interval [CI], 3.4–4.5) and did not change during the study period. The most prevalent malformation was congenital hydronephrosis (14.2% of all cases). Diabetes mellitus or gestational diabetes (odds ratio [OR] = 4.77; 95% CI, 1.16–19.65), acute infections while pregnant (OR = 1.83; 95% CI, 1.14–2.94), the use of medication during pregnancy (OR = 2.03; 95% CI, 1.44–2.82), and conception during the summer (OR = 1.75; 95% CI 1.15–2.66) were significantly associated with higher risk of CAKUTs. CONCLUSION The overall fourfold enhancement of the occurrence of urinary malformations in Murmansk County for the 2006 to 2011 period showed little annual dependence. During pregnancy, use of medications, infections, pre-existing diabetes mellitus, or gestational diabetes were associated with increased risk of these anomalies, as was conception during summer. Our findings have direct applications in improving prenatal care in Murmansk County and establishing targets for prenatal screening and women's consultations. Birth Defects Research (Part A) 106:185–193, 2016. © 2016 Wiley Periodicals, Inc.

Background: One of the most worrying consequence of the production and use of persistent organohalogen pollutants (POPs) is the high accumulation in Arctic populations because of long-range transport. Study of the effects in these populations may illustrate human impacts that are difficult to assess in other locations with lower exposure to these compounds and more diverse pollutant influences. Objective: We aimed to identify the main maternal characteristics influencing on the accumulation of these compounds and the effects on the newborns in a highly exposed Arctic population (Chukotka, Russia). Methods: Organochlorine and organobromine compounds were analysed in maternal venous serum (n = 250). The study included data on residence, educational level, age, parity and body mass index (BMI) from self-reported questionnaires and measured anthropometric characteristics of newborns. Results: Concentrations of β-hexachlorocyclohexanes, hexachlorobenzene, 4,4′-DDT and polychlorobiphenyls were high when compared with those generally found in adult populations later than year 2000. The polybromodiphenyl ethers were negligible. These POP concentrations were higher than in Alaska and Arctic Norway and similar to those in Canada. The Chukotka mothers living in inland areas showed significant lower concentrations than those living in the coast (p < 0.001) except for 4,4′-DDT. The population from the Chukotsky District, a specific coastal area, showed the highest concentrations. Residence was therefore a main concentration determinant (p < 0.001) followed by maternal age, and in some cases parity and BMI (p < 0.05). 4,4′-DDT showed an association with the anthropometric characteristics of the newborns (p < 0.05). Mothers with higher 4,4′-DDT concentrations had longer gestational ages and gave birth to infants with higher weight and length. Conclusions: The maternal accumulation patterns of POPs were mainly related with residence. Most of these compounds were found in higher concentration in women living at coastal areas except 4,4′-DDE and 4,4′-DDT which were of inland origin. This last pesticide was the pollutant showing positive associations with gestational age and newborn's weight and length. To the best of our knowledge, this is the first study reporting statistically significant associations between maternal 4,4′-DDT exposure and anthropometric characteristics of the newborns. © 2019 The Authors, The authors are grateful to all women who participated in the study and the health staff who collected the samples. This study was partially funded by the Norwegian Ministry of Foreign Affairs through the Arctic Monitoring and Assessment Programme (AMAP). Additional funding from the EU projects NEUROSOME ( H2020-MSCA-ITN-2017-766251 ), HEALS ( FP7-ENV-2013-603946 ) and EDCMET ( H2020-SC1-BHC-2018-SEP-210505108 ) is also acknowledged.

Most studies of metals exposure focus on the heavy metals. There are many other metals (the transition, alkali and alkaline earth metals in particular) in common use in electronics, defense industries, emitted via combustion and which are naturally present in the environment, that have received limited attention in terms of human exposure. We analysed samples of whole blood (172), urine (173) and drinking water (172) for antimony, beryllium, bismuth, cesium, gallium, rubidium, silver, strontium, thallium, thorium and vanadium using ICPMS. In general most metals concentrations were low and below the analytical limit of detection with some high concentrations observed. Few factors examined in regression models were shown to influence biological metals concentrations and explained little of the variation. Further study is required to establish the source of metals exposures at the high end of the ranges of concentrations measured and the potential for any adverse health impacts in children.

The size, morphology, and chemical composition of particles deposited in the lungs of two nickel refinery workers were studied by scanning and transmission electron microscopy. The particles were extracted from the lung tissue by low-temperature ashing or by dissolution in tetramethylammonium hydroxide. The suitability of both sample preparation techniques was checked with reference materials. Both approaches lead to Fe-rich artifact particles. Low-temperature ashing leads to oxidation of small (diameter

Background Although predictors of contaminants in serum or whole blood are usually examined by chemical groups (e.g., POPs, toxic and/or essential elements; dietary sources), principal component analysis (PCA) permits consideration of both individual substances and combined variables. Objectives Our study had two primary objectives: (i) Characterize the sources and predictors of a suite of eight PCBs, four organochlorine (OC) pesticides, five essential and five toxic elements in serum and/or whole blood of pregnant women recruited as part of the Mother-and-Child Contaminant Cohort Study conducted in Northern Norway (The MISA study); and (ii) determine the influence of personal and social characteristics on both dietary and contaminant factors. Methods Recruitment and sampling started in May 2007 and continued for the next 31 months until December 2009. Blood/serum samples were collected during the 2nd trimester (mean: 18.2 weeks, range 9.0–36.0). A validated questionnaire was administered to obtain personal information. The samples were analysed by established laboratories employing verified methods and reference standards. PCA involved Varimax rotation, and significant predictors ( p ≤ 0.05) in linear regression models were included in the multivariable linear regression analysis. Results When considering all the contaminants, three prominent PCA axes stood out with prominent loadings of: all POPs; arsenic, selenium and mercury; and cadmium and lead. Respectively, in the multivariate models the following were predictors: maternal age, parity and consumption of freshwater fish and land-based wild animals; marine fish; cigarette smoking, dietary PCA axes reflecting consumption of grains and cereals, and food items involving hunting. PCA of only the POPs separated them into two axes that, in terms of recently published findings, could be understood to reflect longitudinal trends and their relative contributions to summed POPs. Conclusions The linear combinations of variables generated by PCA identified prominent dietary sources of OC groups and of prominent toxic elements and highlighted the importance of maternal characteristics.

Background.The apolipoprotein (apo) B/apoA-I ratio represents the balance between apoB-rich atherogenic particles and apoA-I-rich antiatherogenic particles, and this ratio is considered to be a marker of cardiovascular risk. Although many studies have demonstrated the importance of the apoB/apoA-I ratio in predicting the presence or absence of cardiovascular disease, less is known about apoB/apoA-I ratio as a marker of plasma atherogenicity.Methods.A total of 157 normolipidemic men aged 20–59 years were included in the study. The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apoA-I, apoB, and apoE were determined after a 12 h fasting period.Results. The median of the apoB/apoA-I ratio in the studied normolipidemic subjects was 0.52, with values ranging from 0.19 to 2.60. The percentage of subjects with the apoB/apoA-I ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 19.1%. The subjects with apoB/apoA-I>0.9 were characterized by higher TG levels and atherogenic index of plasma (AIP) and lower values of ratio of low-density lipoprotein cholesterol (LDL-C) to apoB (LDL-C/apoB) and apoE levels compared with men with apoB/apoA-IConclusion. Despite normolipidemia, the subjects with the unfavorable apoB/apoA-I ratio had more atherogenic lipid profile.

The occurrence of organohalogen compounds in venous serum from post-partum mothers from two Argentinian cities, Salta and Ushuaia, has been investigated (n = 698). 4,4'-DDE was the most abundant compound in these cities, with geometric means of 33 and 67ng/g lipid weight, respectively. City of residence, age and parity were the main determinants of the accumulation of these compounds. Hexachlorobenzene (HCB) was the second most abundant pollutant in Ushuaia, 8.7ng/g lipid, and β-hexachlorocyclohexane (β-HCH) in Salta, 7.8ng/g lipid. Decabromodiphenyl ether was higher in Ushuaia than Salta, 8.2 and 4.1ng/g lipid, respectively. The predominance of β-HCH, 4,4'-DDE and 4,4'-DDT in Salta was related with higher use of pesticides for agricultural applications. The observed higher concentrations of 4,4'-DDE and 4,4'-DDT in the mothers from rural+semi-urban sites than in urban areas were consistent with this agricultural origin. In addition, the most volatile organochlorine compounds included in this study, HCB and α-HCH, were mainly found in Ushuaia. The concentrations of the studied organohalogen pollutants in Argentina were lower than those found in other similar studies which is consistent with the location of these cities in the southern hemisphere. Age, mainly for 4,4'-DDE and polychlorobiphenyl (PCB) congeners 138, 153 and 180, and parity, mainly for HCB, β-HCH, 4,4'-DDT and PCB congener 118, were the second main determinants of the concentrations of these compounds. Gestational weight gain also influenced on the maternal levels of HCB, β-HCH, 4,4'-DDT and PCB congeners 118, 138 and 153. Higher weight accumulation during pregnancy involved dilution of these persistent pollutants. Body mass index (BMI) was a statistically significant determinant for 4,4'-DDT, α-HCH and PCB congeners 153 and 180. The observed direct correspondence between higher BMI and 4,4'-DDT concentrations was in agreement with the above reported inputs related with agricultural applications. The reverse correspondence of BMI with α-HCH and the PCB congeners indicated higher dilution at higher weight increase.

Source at https://doi.org/10.1080/22423982.2017.1366785 . The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (≥22 completed weeks of gestation) registered in the Murmansk County Birth Registry (MCBR) and born between 1 January 2006 and 31 December 2009 (n=35,417). The infants were followed-up post-partum for 2 years through direct linkage to the Murmansk Regional Congenital Defects Registry (MRCDR). Birth defects identified and confirmed in both registries constituted the “cases” and corresponded to one or more of the 21 birth defect types reportable to health authorities in Moscow. The overall prevalence of major birth defects recorded in the MRCDR was 50/10,000 before linkage and 77/10,000 after linkage with the MCBR. Routine under-reporting to the MRCDR of 40% cases was evident. This study demonstrates that birth registry data improved case ascertainment and official prevalence assessments and reduced the potential of under-reporting by physicians. The direct linkage of the two registries revealed that hypospadias cases were the most prevalent among the major birth defects in Murmansk County. Abbreviations: ICD-10, International Classification of Diseases, 10th revision; MCBR, Murmansk County Birth Registry; MRCDR, Murmansk Regional Congenital Defects Registry; MGC, Murmansk Genetics Center

Background Lead battery repair workers (LBRW) and electronic repair workers (ERW) may be exposed to inorganic components during work. This study aimed at determining essential and non-essential trace elements in male LBRW, ERW, referents and a group of female petty traders (FPT) in Kumasi (Ghana), taking into account iron status and inflammation. Methods Altogether 64 LBRW, 64 ERW, 65 referents and 26 FPT were investigated in this cross-sectional study. Urine, whole blood and serum were collected for determination of trace elements. C-reactive protein and ferritin were determined in serum. Results The LBRW had higher blood concentrations of manganese (B-Mn) and lead (B-Pb) and antimony in urine (U-Sb), and lower concentrations of cobalt in blood (B-Co). Being ERW was associated with higher concentrations of blood cadmium (B-Cd), urinary tin (U-Sn) and serum chromium (S-Cr). Concentrations of selenium (B-Se), Co and mercury (B-Hg) in whole blood and iodine in urine (U-I) were relatively high. Marginal iron status appeared to be a determinant for elevated concentrations of Co in particular, but also Mn and Cd in blood. Systemic inflammation was associated with the concentrations of copper and Se. The concentrations of Hg in whole blood were highly associated with Se and arsenic (As) in whole blood, indicating fish consumption as a common source of intake of these elements. However, Hg in whole blood was only slightly associated with Se in serum. Conclusions The ERW had elevated concentrations of B-Cd, S-Cr, and U-Sn, while B-Mn, B-Pb, and U-Sb concentrations were higher among the LBRW. Iron status and inflammation had substantial impact on some element concentration. This population had high concentrations of B-Se, B-Hg and B-Co and U-I.

Source at https://doi.org/10.1371/journal.pone.0189534 Background - Knowledge about cervical cancer (CC) risk factors and benefits of CC prevention motivates women to participate in its screening. However, several studies show that there is a significant knowledge deficit worldwide about human papillomavirus (HPV). The current study explores the level of knowledge about HPV and CC prevention in the context of sociodemographic and behavioral characteristics of women who visited an antenatal clinic in Arkhangelsk, Russia. Methods - This cross-sectional study was conducted in the city of Arkhangelsk, which seats the administrative center of Arkhangelsk County, Northwest Russia. It included women who consulted a gynecologist for any reason between January 1, 2015 and April 30, 2015, were residents of Arkhangelsk, 25 to 65 years of age and sexually active (N = 300). Student’s t-test for continuous variables and Pearson’s χ2 test for categorical variables were used in the comparisons of women grouped as having either poor or sufficient knowledge. Linear regression analysis was also employed. Results - The level of knowledge about HPV and CC prevention was associated with education, parity, age of initiating of intercourse, and sources of information. After adjustment, women with university education were more likely to have higher knowledge about HPV and CC prevention compared to those with lower education. Conclusions - We observed that most participants had a sufficient level of knowledge. Educational gaps were identified that potentially could be used to tailor interventions in CC prevention.

PBDEs are a class of brominated flame retardants applied to consumer goods to reduce their flammability. These compounds are lipophilic, persistent and bioaccumulate through the food web. PBDEs have been detected in human blood, adipose tissue and breast milk. There are a small number of studies reporting concentrations of PBDEs in Australian populations. These indicate that concentrations are higher than in studies reporting concentrations from Europe but lower than those from Northern America. The aim of this paper was to determine the concentrations of PBDEs in the plasma of pregnant women participating in the Australian Maternal Exposure to Toxic Substances (AMETS) study in Western Australia. The samples comprised 164 pregnant women, aged 18 years and over, who were non-smokers and not occupationally exposed to persistent substances. Participants provided blood samples at 38 weeks gestation and these were analysed for five PBDE congeners. Maternal health and birth outcomes data were also obtained. The median for sum PBDE concentrations in plasma was 53.9 pg g(-1) (range 13.2 to 1390 pg g(-1)ww). Concentrations were adjusted for the estimated plasma lipid content. The concentrations of Σ5PBDE ranged from 2.44 to 258 ng g(-1) lipid with a median of 9.97 ng g(-1) lipid. BDE-47 was the dominant congener (median 21.4 pg g(-1), range

We have studied social variations in the average birth weight and prevalence of preterm birth over a 30 year period based on data from the Kola Birth Registry (KBR) in Monchegorsk, we also have investigated associations between birth weight and preterm delivery and maternal occupation. Data on 24,602 infants born live from singleton pregnancies with birth weight above 1,000 grams and their mothers were abstracted inform the KBR. Associations between maternal occupation, marital status and birth weight and preterm birth have been studied. Multiple linear regression was used to quantify influences of independent variables of maternal characteristics on birth weight and preterm births. The multivariable logistic regression was applied to study independent associations between the studied factors and preterm births with and without adjustment to potential confounders. The babies born by the unmarried mothers were on the average 101 g (95% CI: -118, -84) lighter than the babies born by the married women. The women from all other occupations except machine operators, mechanical and trade workers had lighter babies compared to the women from the highest occupational category. The babies of the unmarried mothers were more likely to be born preterm (OR=1.73, 95% CI: 1.37, 2.19). Birth weight and risk of preterm delivery are connected with social factors, such as the mother’s occupation and her marital status, admittedly through the economic component.