The rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.Data are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.The rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth , multiple pregnancy , abruptio placentae  and infections . In contrast, provider-initiated preterm birth was associated with private childbirth healthcare , advanced-age pregnancy , two or more prior cesarean deliveries , multiple pregnancy  and any maternal or fetal pathology .The high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority. Preterm birth is the largest risk factor for infant morbidity and mortality, not only in the immediate neonatal period but also in infancy, childhood, and even adulthood . It can Preterm birth can be subgrouped as extreme (less than 28 weeks), severe (between 28 and 32 weeks), and moderate or “near-term” (32 to 36 weeks). In 2005, a committee of experts organized by the National Institute of Child Health and Human Development of the National Institutes of Health (NIH) in the USA suggested the term “late preterm” for newborns with gestational age (GA) between 34 0/7 and 36 6/7 weeks [Recent decades have seen a great increase in the survival of preterm infants, linked to technological advances in neonatal intensive care. The rate of preterm birth has also increased worldwide, largely driven by increases in late preterm birth, often associated with obstetric interventions designed to reduce maternal and fetal complications , 6, 7. IBirth in Brazil was the first Nationwide Perinatal Survey in the country, which allowed the analysis on the relationship between preterm births and obstetric interventions, especially the effect of cesarean sections on the rate of preterm births, using primary-data. Brazil has the world’s highest rate of cesarean section - 57 % of all live births and nearly 90 % among women receiving private healthcare at childbirth, in 2013 [Brazil has a National Information System on Live Births (SINASC) that gather secondary data about GA at birth, therefore allowing the estimation of the prematurity rate for the country. However, this system still fails to provide a reliable GA estimate. Until 2010, GA at birth was collected in broad intervals of gestational weeks, and the prematurity rate was much underestimated (of 7.1 %) with local studies , 10 find in 2013  - sugges in 2013  found thThis study aimed to describe the rate of preterm birth in Brazil by geographic region, childbirth healthcare provision (public or private), subgroups of gestational age and determining factor and to investigate risk factors for spontaneous/pPROM and provider-initiated preterm birth.The “Birth in Brazil” study was a national population-based study of postpartum women and their newborns, carried out from February 2011 to October 2012. It recruited a complex sample of 266 hospitals, with 90 women interviewed in each hospital and a total of 23,940 puerperal women and 24,061 live births. Data were weighted by the inverse of the probability of inclusion of each puerperal woman in the sample. A calibration procedure was used to ensure that the distribution of puerperal women sampled was similar to that observed among the population for the year 2011. Further information on the design of the sample is detailed elsewhere . All wom0/7 to 416/7 weeks, respectively. We excluded 19 newborns with undetermined GA, and 595 post-term newborns (GA of 42 weeks or more). Our final sample was 2,771 premature newborns and 20,677 term newborns, as shown in Fig. In the current analysis, we included all preterm and term live births from the “Birth in Brazil” study, defined as having a GA at birth of <37 weeks and from 37The outcome was the incidence of prematurity, which we categorized as spontaneous/pPROM or provider-initiated. Spontaneous/pPROM preterm births were either with spontaneous onset of labour or with preterm premature rupture of membranes. Provider-initiated preterm births were initiated by labor induction or pre-labor cesarean section. Women with pre labor rupture of membranes who gave birth through labor induction or pre labor cesarean were also classified as spontaneous/pPROM births. We classified as induction of labor women with intact membranes who received medical intervention to initiate uterine contraction before a spontaneous onset of labor, irrespective of whether the type of delivery was vaginal or cesarean. Pre-labor cesarean sections were the sections with no spontaneous or induction of labor.We evaluated the classical risk factors for prematurity including socioeconomic and demographic factors, previous preterm birth, smoking during pregnancy, pre-pregnancy body mass index (BMI), multiple pregnancy, and maternal/fetal conditions during pregnancy. We also evaluated factors that we suspected may play a role in the Brazilian context, including source of payment for childbirth healthcare, number of previous cesarean sections, and adequacy of prenatal care. We organized the variables using a hierarchical model proposed by Victora (1997) . For theWomen who gave birth in public or mixed-funding hospitals  were considered to have received “public childbirth healthcare”. Women whose birth was covered by a private health insurance plan, and those who gave birth in private facilities regardless of coverage by a health insurance plan, were considered to have received “private childbirth healthcare”.Adequacy of prenatal care was assessed using an adapted version of the Kotelchuck Index . This meThe rate of preterm birth was calculated by dividing the number of live births before 37 weeks of gestation by the total number of live births. Differences in this rate were assessed by 95 % confidence intervals (CI), taking into account the sample weights and the clustering design. Differences in proportions of maternal characteristics for spontaneous/pPROM and provider-initiated preterm births, compared with those for term births, were analyzed by chi-square statistical tests with a significance level of <0.05.We performed non-conditional multiple logistic regressions separately for spontaneous/pPROM and provider-initiated preterm birth. In the first multivariable model (Model A), all first-level variables were included. Those with estimated significance <0.10 were included in the second model, along with all second-level variables (Model B). In the third model, first-level and second-level variables with estimated significance <0.10 were analyzed with the third-level variables. All variables with a significance level <0.05 were retained in the final multivariable model (Model C). The results from all models were expressed as adjusted odds ratios (OR) with their corresponding 95 % CI. In all statistical analyses, the complex sampling design was taken into consideration. The statistical program used for analysis was SPSS, version 20.0 .The overall rate of preterm birth in Brazil for the period 2011–2012 was estimated as 11.5 % (95 % CI 10.3–12.9), without significant differences by broad geographic region or type of childbirth healthcare (public or private), but was slightly higher in state capitals. Late preterm was the largest category, at 74 % of preterms, or 8.5 % of all births. Spontaneous/pPROM preterm births made up 60.7 % of all preterm births, and were because of pPROM in about one-third of cases. There was a higher portion of extremely premature births (5 %) in this group than among provider-initiated preterm births (2 %). Provider-initiated preterm births were 39.3 % of the total, due almost entirely (90 %) to pre-labor cesarean section  were associated with spontaneous/pPROM preterm birth. Provider-initiated preterm birth was associated with private childbirth healthcare provision and advanced maternal age, which are characteristics commonly related to greater levels of formal employment and higher levels of schooling and income. Pregnancies where the mother had an infection at admission for birth, which are usually subject to identification and early treatment during prenatal care, were at greatest risk of spontaneous/pPROM preterm birth. All of the investigated maternal and fetal pathologies—especially eclampsia and abruptio placentae—were risk factors for provider-initiated preterm birth.This study has several strengths. First, it is the first to describe preterm birth in Brazil using primary data constituting a representative sample of the entire country. Second, GA was calculated with an algorithm based primarily on early obstetric ultrasound, which confers certain advantages over using date of last menstrual period, as the latter tends to overestimate the rate of preterm birth in the Brazilian population . Third, Our results differ slightly from those of a study of 20 public hospitals that are centers of excellence for high-risk obstetrics in Brazil [The magnitude of the preterm birth rate in Brazil and the frequency of its determinant factors, both for spontaneous/pPROM and provider-initiated preterm birth, were quite similar to those found in US data, despite large differences in socioeconomic conditions and healthcare systems , 21. TheMorisaki et al. , analyziThe excessive medicalization of the management of labor and delivery is regarded as one of the characteristics of the current obstetric care transition in Brazil . With a The contradiction between higher socioeconomic status and a greater frequency of maternal and fetal pathologies among provider-initiated preterm births can be explained by the more advanced age of these women, and a greater history of prior preterm births and cesarean sections, which probably leads practitioners to opt for expedited birth through an earlier intervention. For those women, who receive mainly private healthcare at childbirth, it appear that any potential risk condition become the motive to perform caesarean sections, despite some recent government effort to avoid it. The association of provider-initiated preterm birth with all of the investigated maternal pathologies may argue that there is a need for better national implementation of clinical protocols for appropriate indication of provider-initiated birth, with possible considerations such as waiting until term or after 39 weeks . The assAnother important fact to highlight was the lack of induction of labor in provider-initiated preterm deliveries, despite the evidence of the benefits of labor for neonatal extrauterine life and colonization with maternal microbiota, which could attenuate the disadvantages facing preterm neonates .The role of infection in spontaneous/pPROM preterm birth underscores the importance of quality prenatal care. Many authors point to the importance of preventive measures during gestation to minimize premature birth. We recommend the early initiation of prenatal care, especially among adolescents, the most vulnerable group. Domingues et al.  found thLate prematurity was found at high levels in our study and represents three-quarters of all preterm births in Brazil. Given current knowledge about the crucial importance of gestational weeks 34 through 36 to the development of the neonate and the risks arising from late preterm birth , 31, 32 Khan et al.  analyzedThe high rate of prematurity in Brazil may be attributed to a high proportion of provider- initiated births, especially among women receiving private healthcare at childbirth. Its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that the reduction of prematurity may be possible by supporting the postponement of intervention in cases without clear evidence of maternal-fetal benefit. The association of spontaneous/pPROM prematurity with socially-disadvantaged groups confirms that the reduction of social and health inequality should continue to be a national priority.


The 1-mm thickness of the electrolytically polymerized MCF rubber makes production of comparatively thin rubber sensors feasible. We first investigate the effect of magnetic particles Ni and Fe3O4 on the curing of MCF rubber. Next, in order to adjust the electric properties of the MCF rubber, we adopt Al2O3 dielectric particles. We investigate the effect of Al2O3 particles on changes in electric current, voltage and temperature of electrolytically polymerized MCF rubber liquid, and on the electric properties under the application of normal and shear forces. By adjusting the ratio of Ni, Fe3O4, Al2O3 and water in MCF rubber with Al2O3, it is possible to change the electric properties.The aim of this study is to investigate the effect of particles as filler in soft rubber sensors installed in artificial skin. We examine sensors made of natural rubber (NR-latex) that include magnetic particles of Ni and Fe In robotics, it is sometimes necessary for sensors to be both very soft and extensible, as when they are installed in the artificial skin of robots. It is expected that robots will soon be providing humans with domestic help, in the nursery, in hospitals, etc. To enable humans to feel an affinity to robots, there has been a recent demand for a material that is similar to human skin. The rubber selected for sensors should not be vulnerable to impulsive or immense force. To create robot skin, rubber is needed that is durable so as to withstand large forces, while retaining considerable softness and expansion capability .In addition, it is desirable for robot skin to have high haptic sensing like human skin. Haptic sensing can be obtained by measuring the changes in electrical resistance or dielectrics between the electrodes installed in a sensor under the application of extraneous force. The electric property changes due to the softness of the rubber material.3O4 [3O4 10-nm order thick sphere particles coated with oleic acid, as well as 1-μm order thick metal particles such as Ni, etc. Fe3O4 particles are dispersed in magnetic fluid (MF) with a mixing solvent such as water, etc., which is responsive to a magnetic field. When a magnetic field is applied, owing to the bonding role among the metal and Fe3O4 particles, numerous magnetic clusters form [Therefore, it is important to examine the electric properties of soft rubber haptic sensors. The electric, as well as mechanical, property of many types of rubber sensors has already been investigated, including natural rubber (NR-latex) ,3,4,5,6,3O4 . It is u3O4  as an iners form . These mRubber that includes MCF as a composite material is called MCF rubber. The magnetic clusters in MCF rubber produce high electric conductivity at a very small pressure. The mechanism of electric conductivity has been explained mainly by the percolation  and tunn4 Pa, a characteristic value found in number of studies [In the case of MCF rubber made of NR-latex, the application of an electric field works to electrolytically polymerize the MCF rubber sufficiently to create high electric conductivity, as shown in our previous studies ,11,12. I studies . In cont studies . In the 3O4 particles involved in filler MCF rubber are a significant factor. Here, we dealt with 1 mm thick electrolytically polymerized NR-latex MCF rubber since it is more feasible for the production of a sensor [3O4 magnetic particles on the curing of 1 mm thick electrolytically polymerized NR-latex MCF rubber.The aim of the present study is to develop a soft rubber made of NR-latex for application as a high-haptic sensor in artificial skin. It is important to investigate how to control sensitivity in the production process. The Ni and Fea sensor ,11,12. Ia sensor ,11,12, wAs is well known, in terms of dielectrics, sensor characteristics can be divided into four types: paraelectrics, piezoelectrics, pyroelectrics, and ferroelectrics. Therefore, if dielectric materials are often used as particles in polymer blends (corresponding to filler), the sensor could have a range of possible sensitivities. Moreover, the use of dielectric materials as filler is one of the best ways to enhance the electrical, thermal, mechanical or curing properties of a composite material ,20,21,222O3 as filler, and decrease electric conductivity by varying the mixture of dielectric materials. We also examine the effect of the Al2O3 particle on electric conductivity, using the same measurement apparatus used in our previous studies [However, more study is needed on the available properties of MCF rubber mixed with dielectric particles for sensors. In this study, we therefore investigate ways of controlling the electric properties of MCF rubber. We adopt the dielectric particle Al studies ,11,12.The New Method used to produce MCF rubber has been described previously ,11,12. B3O4, as shown in 3O4 , and NR-latex was from Rejitex Co. Ltd. . Type 1 corresponds to the MCF rubber liquid used in our previous reports [We used five types of MCF rubber (Types 1–5) with different mass concentration ratios of magnetic particles Ni and Fe reports ,11,12.On the other hand, with a small magnetic field strength, the MCF rubber liquid gradually became solid before electrolytic polymerization, and was more vulcanized by polymerization. In addition, the smallest and largest mass concentrations were more solidified by electrolytic polymerization. Thus, results indicated that when MCF rubber liquid had mixed solid and liquid states, even if it presented as extremely solid or liquid, it was more vulcanized by electrolytic polymerization.−4 Ω·m. In comparison, the leading commercial NR-latex pressure-sensitive electrically conductive rubbers (PSECR) has 1-ordered Ω·m after thermal degradation. Metals such as silver and copper have 10−7-ordered Ω·m. In the case of plastic-type electric conductive polymers, polyphenylene-based conductive plastic doped with ASF5 has 10−2 ordered Ω·m. MCF rubber can therefore have electric conductivity closer to that of metal, depending on the dopant and filler. However, robotics occasionally requires sensors that are able to respond to sensitivity over a range of electric conductivity; thus, adjustable electric conductivity is needed. As mentioned, higher electric conductivity has been well-developed, while degradation of electric conductivity requires further investigation. In order to decrease electric conductivity, it is best to use dielectric material. Our previous investigations ,11,12 de2O3  in the three ingredient combinations listed in 3O4 . It was separately confirmed that the effect of different kinds of MF (like W-40 and M-300) on the electric properties of electrolytically polymerized MCF rubber was not an issue.We used 3 μm sphere particles of Al2O3 particles, MCF rubber liquid close to a solid state did not change to a mixed solid/liquid state either with or without the magnetic field. The Al2O3 particles kept the MCF rubber liquid closer to a solid state.2O3 compared to that without (Type 1). Compared to Types 6–8, Type 1 rubber was the same weight of NR-latex, MF and Ni. In our previous study of Type–1 MCF rubber liquid [We measured the voltage and electric current flowing inside the MCF rubber liquid under the application of both electric and magnetic fields, as described in our previous studies ,11,12. Fr liquid ,11,12, e2O3, the temperature and electric current did not change as a result of the addition of the dielectric material. Here, a comparison of Types 7 and 8 shows that both temperature and electric current increased when water was added. Water plays a significant role in electrolytic polymerization. However, Types 7 and 8 MCF rubbers were vulcanized dry. The aridity of Type 8 MCF rubber was distinctly greater than that of Type 7. Electrolytic polymerization also vulcanized all of MCF rubber Types 6–8, according to the solidification phenomena categories in 2O3 was included in electrolytically polymerized MCF rubber, it became like a rigid solid.In contrast, in the MCF rubber with AlWe investigated the electric properties of vulcanized MCF rubber under the application of pressure and shear force. We used the same experimental apparatus described in our previous study ,11,12. WFirst, we measured the electric current, voltage, or electrical resistance between the opposing electrodes by applying a normal force to the vulcanized MCF rubber. By accomplishing the data, an electric power 10 V was supplied and 1.8 kΩ electric resistance used. The MCF rubber placed between the two 7 mm stainless steel square electrodes was vulcanized. The upper electrode was moved to touch the lower one by an actuator. The pressing speed was 10 mm/min. MCF rubber test specimens were 1 mm thick, compressed between the counter electrodes. For convenience, this experimental procedure is called by NFE.aR with 20.86 μm, yR with 199.9 μm, and qR with 26.89 μm surface roughness, and was moved parallel to the material surface by an actuator. The speed was 5 mm/s, and a sweeping distance was 50 mm. Between the MCF rubber and the acrylic resin body, a hard, non-electric body with 0.5 mm diameter was interposed, and then the rubber could be contacted exactly. This touching method was found to be more effective in a sensor, as shown in the previous study [Second, in order to measure the electric current, voltage, or electrical resistance within the vulcanized MCF rubber under a shear force, we used another experimental apparatus. As with the NFE, the power 10 V was supplied and the electric resistance of 1.8 kΩ used. Between the two electrodes of the stainless plate, both tips of the vulcanized MCF rubber were placed. The MCF rubber touched a rubbing flat plate. It had a us study ,12. Beca2O3 and water. In Types 7 and 8 with 30 min (and Type 6 with 30 min at less than 0.1 N), the fluctuation of electrical resistivity is large and does not decrease much with increasing normal force. Aside from these types, electrical resistivity decreased. The characteristics were sufficient to create a switching effect in a sensor—when normal force reaches some targeted value, the electric current can start flowing.In the case of the NFE in 2O3 in a range of less than 0.15 N, electrical resistivity worsened with longer vulcanization time. However, Type 1 without Al2O3 did not deteriorate. This was thought due to the hard aridity of the Al2O3 MCF rubber by electrolytic polymerization. Because Al2O3 is hygroscopic, the water in the MCF rubber is not lost in shorter electrolytic polymerization; however, it is lost with lapsed electrolytic polymerization. The electric conductivity depends on the ions generated by the water or molecular structure of the NR-latex. In addition, when water is involved in the MCF rubber, rubber temperature under electrolytic polymerization increases, as shown in Type 8 in 2O3 was increased, however, as in Type 6, electrical resistivity to pressure changes decreased, even at pressures of more than 0.15 N. Thus, electrolytic polymerization can be altered by adjusting the ratio of Ni and Al2O3 in the MCF rubber.When the MCF rubber included Al2O3 degrades electric conductivity, whereas water improves it. The deterioration changes the ratio of water, Ni, and Al2O3.Next, we investigated the shorter vulcanization time of 5 s. AlR is the change in electric resistance with strain, oR is the initial value of electric resistance, and ε is the strain. Strain has been investigated in polymers [In addition, the characteristics shown in polymers ,24,25 anpolymers ,28,29,30polymers ,28,29,30By expanding Equation (1) to the experimental condition of compression, GF can be considered as the gradient of the curve of 2O3 particles are involved. The MCF rubber was then transformed by pressing, as shown in 3O4 and Al2O3 particles are non-conductive. Due to their optimum mass concentration, the electric current cannot flow easily, and electric resistance is large to the pressure. However, the electrons jump between the non-conductive materials. Electric resistance changes decrease exponentially by pressing, and the phenomena for compression can be explained by tunnel theory, just like for strain [The electrolytically polymerized MCF rubber has many needle-shaped magnetic clusters, like those shown in r strain ,26.2O3, and vulcanization time. This is not due to the independent existence of Al2O3 and water, but rather to the difference in the morphological structure of the MCF rubber by electrolytic polymerization to the normal and shear deformation. In the SFE, the magnetic field was applied along the direction of the electrolytic polymerization between the electrodes, which was traversed to the deformation by the shear motion. In contrast, in the NFE, it was in the same direction as the deformation by compression. The morphological structure of the MCF rubber by electrolytic polymerization can be proposed as three layers, and the magnetic clusters of Ni and Fe3O4 and NR-latex combined into complicated structures, as shown in previous studies [Meanwhile, in the NFE in  studies ,11,12. E3O4 magnetic particles on the curing of electrolytic polymerization of the MCF rubber. We found that MCF rubber maintains a more liquid state before electrolytic polymerization at a larger magnetic field strength, and is not vulcanized sufficiently by electrolytic polymerization. This tendency does not depend on the mass concentration. In contrast, at a smaller magnetic field strength, MCF rubber liquid gradually assumes a more solid state before electrolytic polymerization, and then is more vulcanized by polymerization. In addition, at the smallest or largest mass concentrations, it is more solidified by electrolytic polymerization. These results indicate that when MCF rubber liquid has mixed states of solid and liquid, even if it presents strongly one way or the other, it will be more vulcanized by electrolytic polymerization. The reason for these results is related to the density of the magnetic clusters, which is determined by the magnetic field strength and the mass concentration of magnetic particles.We first clarified the effect of MCF, Ni and Fe2O3. Temperature and electric current under electrolytic polymerization do not change by the addition of Al2O3. However, MCF rubber with Al2O3 is electrolytically polymerized, like a rigid solid. In contrast, by involving water, the temperature and electric current under electrolytic polymerization increase. Water plays a significant role in electrolytic polymerization. The MCF rubber can become so dry that its electric conductivity to pressure is aggravated. However, the ratio of Ni to Al2O3 in MCF rubber is increased, while the electrical resistivity to pressure changes decreases. Thus, electrolytic polymerization changes by adjustments to the ratio of Ni, Al2O3, and water in the MCF rubber.Next, in order to adjust electric conductivity, we determined the best way to use the dielectric material, Al2O3, electrical resistivity to pressure worsens with longer vulcanization time. With shorter vulcanization time, due to more water, electric conductivity to pressure improves. The deterioration changes the ratio of water, Ni, and Al2O3. On the other hand, the electric property under shear motion is different from that under pressure. Electric sensitivity under shear motion is enhanced by a larger ratio of Ni to Al2O3, and a shorter vulcanization time.Regarding electric property, for MCF rubber with Al3O4 magnetic particles only does not exceed the solidification achieved by MCF rubber that includes Al2O3. However, by adjusting the ratio of Ni, Fe3O4, Al2O3, and water, electric properties of MCF rubber with dielectric particle Al2O3 to pressure and under shear motion can be changed. This technique of adjusting the electric properties is significant for the requirement of sensing at an overall force range in robotics.As a result, MCF rubber with Ni and Fe


Objectives. This study aims to evaluate perinatal outcomes such as gestational age at delivery and live birth rate in singleton and twin gestation with or without fetal reduction. Method. A retrospective analysis was done on patients which were divided into reduced and unreduced groups on the basis of order of reduction of one or more fetuses between 6 and 13 weeks of gestation. Patients records were studied to note gestational age at delivery/abortion, birth weight, and neonatal outcome. Result. The cohort included a total of 292 patients: 102 singletons and 190 twins. 52 pregnancies were reduced in singleton cohort and 68 were reduced in twin cohort. No statistical difference was observed in live birth rate, gestational age at delivery, and birth weight and significant higher incidence of IUGR was observed in reduced and unreduced twin gestation. In singleton pregnancies however preterm delivery rate increased with fetal reduction. Conclusion. Although reduction does not reduce the live birth rate, it does reduce gestation age of delivery and birth weight of newborn. This effect is more apparent when multiple gestation is reduced to singleton. In this era of exponential industrialization and global changes, lifestyle disorders like infertility are on the rise. It is estimated that infertility affects 8 to 12 per cent of couples worldwide [The need for single embryo transfer has been highlighted in recent studies globally but it is limited because of several obstacles. The complications of multiple gestation  are often ignored by both the couple and the physician against the instant gratification provided by increase in pregnancy rate.At the end when primary preventive strategies to prevent multiple pregnancies have failed or circumstantial considerations have warranted transfer of higher number of embryos resulting in multiple gestation, fetal reduction is an interventional step to be considered. As stated in 2006 by the International Federation of Gynecologists and Obstetricians Ethics Committee Report, “multiple pregnancy of an order of magnitude higher than twins involves great danger for the woman's health and also for her fetuses, which are likely to be delivered prematurely with a high risk of either dying or suffering damage,” and “where such pregnancies arise, it may be considered ethically preferable to reduce the number of fetuses rather than to do nothing” .Taking into account the legitimacy of the procedure, a related concern is whether fetal reduction to twins further compromises the outcome of the reduced pregnancy as compared with a twin pregnancy that had not undergone such a procedure. There has been dilemma over the advantage of fetal reduction due to contrasting results by various studies –6.Since perinatal outcome may vary with regional factors like level of medical care and patient profile, this study helps bring forth the answers to these questions in the context of central India. Therefore the aim of this study was to compare perinatal outcome of pregnancies conceived through ART—singleton versus twin gestation. Effects of reduction in multiple pregnancies by comparing reduced singleton and twins with their unreduced counterparts were also analysed.This retrospective cohort study was performed in the Department of Reproductive Medicine and Surgery in Sri Aurobindo Medical College and Post Graduate Institute during January 2012 and December 2015. All patients who conceived by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) were included in the study. Only patients who had aborted or delivered during the study period were included. Details of pregnancies were recorded in the departmental record in the form of individual patient file which was periodically updated either at time of patient follow-up visit or by telephonic enquiry.Patients, who were lost to follow-up, had incomplete records, had heterotopic pregnancies, had monochorionic pregnancies, or had decided to continue triplet or higher order gestation, were excluded from the final evaluation. Patients who aborted all the fetuses before 13 weeks spontaneously or following MFPR were also excluded from the final evaluation.β-HCG levels were expected to be 2000 mIU/mL or more between 5.5 and 6.5 gestational weeks (3.5 to 4.5 weeks after embryo transfer). USG was repeated every 2 weeks until the 12th gestational week, transvaginally. Pregnant women were followed up in the department under a fetal medicine specialist till 12 weeks. Patients presenting to local obstetrician were followed up periodically on telephone.As per departmental protocol, ultrasonography (USG) was initially performed to determine the location and number of gestational sacs when quantitative In patients with triplet or quadruplet gestation multifetal pregnancy reduction (MFPR) at 11–13 weeks was done such that 2 fetuses were reduced in quadruplet pregnancies and single fetus was reduced in triplet pregnancies. Fetal reduction was performed transabdominally under USG guidance after establishing chronicity and nuchal translucency. Any fetus who appears abnormal or had increased nuchal translucency was chosen for fetal reduction. Otherwise in all normal looking fetuses one who was located near fundus was chosen for reduction. The period of 11–13 weeks was chosen for the MFPR for selecting the fetus with increased nuchal translucency for reduction. The procedure was performed by injection of approximately 2 to 3 mL of potassium chloride (concentration 2 mEq KCl/mL) into the fetal thorax using an 18-gauge spinal needle by a single operator.Group A: USG showing single live fetus were defined as singleton gestation.Group B: USG showing twins gestation were defined as twins gestation.These groups were further subdivided into reduced and nonreduced group.Two study groups were defined on the basis of USG findings at 13 weeks.Fetal reduction (FR) was defined as disappearance of gestational sac or loss of cardiac activity in one or two gestational sacs (after its identification). Patients who lost one or more fetuses spontaneously before or after MFPR (but before 13 weeks) were included in reduced group. Fetal reduction could have occurred spontaneously or iatrogenically due to induced fetal reduction procedure.Nonreduced group: a number of live fetuses at six weeks were similar to those seen at 13 weeks.In the reduced pregnancy group note was made according to the number of fetuses reduced .For each pregnancy included, the following data were retrieved from the medical record: maternal age, parity, fetal reduction procedure, gestational age (in weeks) at abortion/delivery, birth weights, and number of live-born infants.Late abortion was defined as disappearance of cardiac activity in utero or delivery before 28 completed weeks of gestation. Preterm delivery was defined as birth of a viable baby (after 28 weeks) at or before 37 completed weeks of gestation. Very preterm delivery was defined as birth of a viable baby between 28 to 32 weeks of gestation. Neonatal death was defined as death of a live baby within 4 weeks of delivery. Restricted fetal growth or IUGR was defined as a birth weight less than the 10th percentile for gestational age on the basis of national singleton birth weights [The outcome variables studied in the present study were pregnancy loss, weeks of gestation at delivery, birth weight of the baby, and incidence of IUGR.t-test wherever applicable to determine statistical significance. Association of number of fetuses with perinatal outcome was evaluated using chi-square test.Measurement data underwent normality test and were expressed as mean ± standard deviation. The maternal and fetal parameters of the two groups were compared using chi-square test and p < 0.05.One-way analysis of variance (ANOVA) was used to calculate the significant difference in mean gestational age at delivery and birth weight in different subgroups . Statistical significance was established at A total of 292 patients were included in the study. Out of 292 patients 102 patients had single and 190 patients had twin gestation at 13 weeks of pregnancy on the basis of number of fetuses seen in transvaginal scan.52 pregnancies (6 from triplets to singleton and 46 from twins to singleton) were reduced to singleton either spontaneously or iatrogenically in singleton cohort whereas 68 pregnancies (11 from quadruplets to twins and 57 from triplets to twins) were reduced to twins in twin cohort.In singleton group, with multigravida patients out of 13 only 4 patients had previous conception that crossed the period of viability. In twins group out of 16 multigravida patients only 5 patients had previous conception that had crossed the period of viability.p = 0.1881 and 0.983, resp.)  . Prepregp = 0.259 and 0.832, resp.). However unreduced singleton pregnancies had significantly higher chance of term delivery in comparison to those who underwent fetal reduction (p = 0.0421). Similar comparison in twin gestation did not show any statistical significance.The percentage of patients who had live birth also is similar in reduced and unreduced pregnancy in both singleton and twin gestation . A similar pattern was noted in terms of birth weight too. A statistically significant association was seen with no fetal reduction and higher birth weight in singleton gestation (p = 0.012)  .In the present study 190 patients with twin gestation delivered 394 babies. The patients were divided into 3 subgroups. Subgroup (4 to 2) was those in whom quadruplet gestation at 6 weeks was reduced to twins by 13 weeks (MFPR or SPR). Similarly 3 to 2 formed another subgroup while patients who conceived twin gestation and continued without any fetal loss till 13 weeks were put in the last subgroup. In 4 to 2 subgroups 4 pregnancies and in 3 to 2 subgroups 16 pregnancies were reduced spontaneously.p = 0.874), gestational age at delivery (p = 0.572), and birth weight (p = 0.566)  . In pati= 0.566) .A total of 394 babies were delivered at or later than 28 weeks (period of viability) as singleton or twin pregnancies. The chance of higher birth weight was significantly more in patients where fewer fetuses were reduced. In singleton pregnancies, which did not undergo fetal reduction, the babies had significantly higher birth weight. Overall 40.1% babies had birth weight above 2.6 kg and 66.23% (51/77) of them were singleton pregnancies at 13 weeks. In cases of twin deliveries, 26 babies have birth weight above 2.6 kg. Out of these 65.38% (17/26) did not undergo reduction .Even though elective single embryo transfer is ideal in certain circumstances, as in repeated failure cases, we sometimes deliberately transfer a large cohort of embryos, thus taking a thoughtful risk for a high order gestation. In other cases, owing to a limited ability to select the embryos with the highest chance for implantation, we may also choose the introduction of multifetal transfer, knowing our patient may end up with a multifetal pregnancy.We have found no association of age and previous parity on the perinatal outcomes in any groups—reduced singleton/twins and unreduced singleton/twins. This is in contrast to many studies done in past which consider increasing maternal age  and nullThis study demonstrates no clinical difference in abortion rate in reduced and unreduced pregnancy (both singleton and twin gestation). In fact, it was little higher in the unreduced twin pregnancies. Similar results were seen in previous study also . This noPresent study shows that singleton gestation has better perinatal outcomes than twin gestation. Pregnancies that had undergone reduction to singleton also fared better than those reduced to twins though these differences did not reach statistical significance in terms of average gestational age at delivery and live birth rate. However lower birth weight and preterm deliveries in singleton pregnancies were significantly associated with those who had undergone reduction. It is pertinent to point out here that reduced singleton birth weight though lower than unreduced singleton was significantly higher than reduced twin gestation.It is important to mention that some previous authors  have fouIn a prospective study  which coThe incidence of IUGR was higher in reduced twins as compared to unreduced twins. Similar to our study Depp et al.  reported two consecutive singleton pregnancies and, in addition, should be adjusted for lower outcome risks for IVF twins and higher risks for IVF singletons if obstetrical risk data are utilized in risk comparisons between singleton and twin pregnancies. Though such comparison is beyond the scope of present study, we also believe that twin gestation does avoid additional infertility treatments especially in Indian scenario where two children are often a norm.Gleicher et al. , 14 in tIn a prospective observational study it was seen that as the initial number of fetuses increased (in pregnancies reduced to twins) the risk of miscarriage increased and gestational age at delivery decreased . This stIn a large prospective study  when sinThe strength of the present study is that the data was not influenced by performance variability for fetal reduction and nature of treatment. The study also attempts to eliminate bias arising due to maternal indications of pregnancy termination.Lack of adherent follow-up and retrospective nature of the study are its main limitations. Due to this it was difficult to validate the quality of care delivered especially in patients who were followed up elsewhere.Twin pregnancies are at higher risk of lower birth weight and preterm delivery whether they undergo reduction or not. Although reduction does not alter the live birth rate, it does reduce birth weight and gestation age of delivery and the effect is more apparent when multiple gestation is reduced to singleton. Singleton pregnancies fare better than twin pregnancies so ultimate goal of an ART cycle should be the BEST (blastocyst euploid selective transfer).Our data does not show any statistical difference in the perinatal outcome of reduced versus nonreduced twins; however long term follow-up to study the consequences of reduction is required.


Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions even in the countries where the disease is endemic. Intracranial hydatid cysts are more common in children and occur more frequently in the supratentorial space. The aim of this paper is to describe the characteristic features of computed tomography (CT) and magnetic resonance imaging (MRI), and to determine the clinical presentation and surgical outcome of cerebral hydatid disease. A 7-year-old girl was admitted to the emergency department because of an epileptic attack. On radiological examination a round, cystic lesion appeared in the parietal lobe and caused shift of the midline structures. The cyst was successfully removed using the dowling technique. The postoperative period was uneventful and seizures were not seen during follow up. Hydatid cyst of the brain presents clinically as intracranial space occupying lesion and is more common in children, it is well demonstrated by CT and MR examinations, and Surgery is the treatment option with affordable morbidity and low mortality. Hydatid disease (echinococcosis) is a worldwide zoonosis produced by the larval stage of the Echinococcus tapeworm . This isHistory and examination: This 7-year-old girl, previously healthy, was admitted to the emergency department for an epileptic attack, she described four episodes of partial seizure secondary generalized. Neurological examination revealed postictal confusion, hemiparesis and bilateral papilledema. Headache and vomiting were not experienced. An anticonvulsant therapy was administrated. Magnetic resonance images (MRI) demonstrated well-defined round  entirely surrounded by brain parenchyma hypointense lesions on T1-weighted images  and the lung (8.5-43%) are the organs most commonly involved. The remaining lesions may involve any organ in the body, including cerebral involvement in approximately 2% of patients infected with the parasite . They maIn cystic echinococcosis, the parasitic cyst consists of an inner germinal layer (endocyst) and an outer laminated layer (ectocyst). The host reacts to the cyst by forming a fibrous capsule (pericyst), which contains blood vessels that provide nutrients for the parasite. From the germinal layer, scolices, brood capsules, and daughter cysts are formed by endoproliferation  .Cerebral cystic echinococcosis is most commonly seen in children and young adults (approximately 50–70%) . El- ShaThe lesions may remain asymptomatic until they are quite large. Headache and vomiting were the most commonly reported symptoms in other series. Other symptoms such as hemiparesis, seizures, visual field alteration and gait disorders, may vary with the location of the cyst . PapilleLesions of cerebral hydatid disease are usually distributed in the territory of the middle cerebral artery, especially in the parietal lobe. Most of the cysts are located in the supratentorial regions , 6, and Multiple cerebral hydatid cysts are rather rare and result from spontaneous, traumatic or surgical rupture of a solitary primary cyst or as a consequence of a cyst rupture elsewhere and embolization of hydatid to the brain , 10. ThePatients with cerebral hydatid cysts may have hydatid cysts in other organs. In recent studies, hepatic, pulmonary and other locations were found in 10% of the cases . In the Both CT and MRI demonstrate a spherical and well-defined, smooth, thin walled, homogeneous cystic lesion with fluid density similar to the cerebrospinal fluid, with or without septations or calcification. On unenhanced CT, the cyst wall was isodense or hyperdence to brain tissue. The cyst wall usually showed a rim of low signal intensity on both T1- and T2-weighted images. Calcification of the wall was rare, being less than 1%. The presence of daughter cysts is considered pathognomonic but has been rarely reported . ObviousThe differential diagnosis of intracerebral hydatid cysts includes cystic lesions such as porencephalic cyst, arachnoid cyst, cystic tumor of the brain and pyogenic abscess. In contrast to hydatid cysts, porencephalic cyst and arachnoid cysts are not spherical in shape and not surrounded entirely by brain substance. Arachnoid cysts are extra-axial masses that may deform adjacent brain. Porencephalic cysts result from insults to normal brain tissue and are lined by gliotic white matter that could easily be demonstrated with MR imaging. Cystic tumors of the brain could be differentiated by the enhancement of the mural nodule, if any, and periphery of the tumor. When a pyogenic abscess shows a cyst-like central necrotic area; peripheral edema is almost always present, the rim enhances intensely following contrast administration and satellite lesions are commonly present, all of which could be demonstrated on both CT and MR images. Clinical and laboratory findings could also aid in the differential diagnosis of the patients with cerebral abscess formation.The diagnosis should be suggested by evidence of a primary hepatic focus, appropriate clinical history, high prevalence of the infection in the host’s geographic location, and laboratory findings . CerebraIn conclusion, CT and MR imaging, alone or in combination, are helpful in the diagnosis of cerebral hydatid disease. Although CT is superior in detecting calcification of the cyst wall or septa, when present, MR is better in detecting multiplicity and defining the anatomic relationship of the lesion with the adjacent structures and helps in surgical planning. MR provides additional information and details that cannot be seen by CT. It provides additional information in the exact localisation of the cyst. When present, in complicated or recurrent disease, surrounding edema can better be demonstrated with MR imaging owing to the inherent capability of the imaging modality in revealing subtle differences in the tissue content. When a well-defined spherical cystic intracerebral lesion with obvious mass effect, but no surrounding edema and no contrast enhancement following contrast administration is detected on CT and MRI, hydatid disease should be taken into consideration in countries where the disease is endemic. If perilesional edema and thin rim enhancement are observed either complicated hydatid cyst or other cystic lesions of the brain should be considered in the differential diagnosis.The treatment of cerebral hydatid cysts is principally surgical. The primary goal of the operation is total cyst extirpation without rupture to prevent anaphylactic reaction and local recurrence . Many diDespite the advancements in microsurgical operative techniques and instrumentation, cerebral hydatid cysts pose a challenge for the surgeon because of the following characteristics: they are usually diagnosed when they are large in size; they have a very thin cyst wall; the neurological deficits are often minimal in their presentation despite the location and the large size of the cyst; and they are sometimes located deep or near the ventricular wall and require retraction of vital structures or meticulous cortical dissection. There are many reports suggesting that the Dowling technique is the most effective surgical procedure for the removal of cerebral hydatid cysts. However, some pitfalls exist with this technique concerning surgical methods, instruments, and cyst location. The best operative approach to a cystic lesion in the brain should be based on the site and the size of the cyst, and the relationship of the lesion with the other neural and vascular structures.Few reports mention the efficacy of drug therapy with albendazole in the cure of cerebral hydatid cyst . HoweverWe concluded that hydatid disease is not uncommon, affects pediatric age group and is usually located supratentorially. The clinical features are those of intracranial space occupying lesion. It can safely be removed intact with the dowling technique.


Studies using mothers’ self-reported information on birth and pregnancy characteristics are common, but the validity of such data is uncertain. We evaluated questionnaire data from the RHINE III study on reproductive health provided by 715 mothers from Bergen, Norway, about their 1629 births between 1967 and 2010, using the Medical Birth Registry of Norway (MBRN) as gold standard. Validity of dichotomous variables  and Cohen’s kappa. Paired t-test, Pearson’s correlation coefficient and Bland-Altman plots were used to validate birthweight, stratified by mother’s level of education, parity, birth year and child’s asthma status. Child’s gender and caesarean section showed high degree of validity . Instrumental delivery and extremely preterm birth showed good agreement with sensitivity 75–92%. Preterm birth and induction of labour showed moderate agreement. Post-term delivery was poorly reported. The validity appeared to be independent of recall time over 45 years, and of the child’s asthma status. Maternally reported birth and pregnancy information is feasible and cheap, showed high validity for important birth and pregnancy parameters, and showed similar risk-associations compared to registry data. Over the past decades, there has been increasing interest in the effects of prenatal exposures on disease predisposition in adulthood , 2. In mThere are studies validating maternally reported data against nation-wide registry data , while oThe aims of the present study were to investigate 1) the validatity of maternally recorded birthweight, gestational age, mode of delivery  use of forceps/vacuum and induction of labour; 2) whether the validity of mothers’ reported birthweight as well as other maternal characteristics differed by the number of years from birth until report. We used a datasource with information about asthma-status in the child, known at the time the mother reported information about birth and pregnancy, and thus used this as an example to investigate whether mothers’ reporting differed if the child had a specific disease (asthma) or not.www.ecrhs.org). The RHINE III constitutes the second questionnaire follow-up of a population-based cohort from seven Northern European centres (www.rhine.no) [The Respiratory Health In Northern Europe (RHINE) study was initially recruited as part of the European Community Respiratory Health Survey (ECRHS) I stage I (hine.no) . An exteIn the third stage of RHINE in Bergen between 2010 and 2012, 2364 individuals participated, among which 1093 were women. Out of these, 859 women filled in and returned the women’ s health questionnaire . All womThe Medical Birth Registry of Norway (MBRN) is a nation-wide population-based registry established in 1967. Registration of information on all live births and stillbirths in Norway from 16 weeks of gestation is mandatory. Data from the antenatal forms carried by all pregnant women are transferred to the MBRN registration form after delivery, together with data recorded at the maternity ward by the midwives. The variables in the registry have been validated against patient records and found to be satisfactory –17. In oBased on the RHINE III mothers’ unique personal identification numbers and self-reported birth years for the children we were able to match 1629 children (95%) from 715 RHINE III mothers with data from the MBRN . MaternaDescriptive statistics about the mothers and the children were reported as mean (SD) for numerical variables, median and inter-quartile range for discrete variables and counts and percentages for categorical variables.Validity of dichotomous variables was assessed by sensitivity, specificity, positive and negative predictive values (PPV and NPV), and Cohen’s kappa. Data from the MBRN were treated as the gold standard in all analyses. Mother’s self-report of birthweight for her child was validated using paired Pearson’s correlation coefficient and constant-only linear regression models with the difference between mother’s reported birthweight and the birthweight in the MBRN as the dependent variable. The estimated constant with confidence intervals indicates systematic bias. Confidence intervals were corrected for clustering within mothers by using a clustered sandwich estimator for the standard errors. We stratified the analyses by level of education, the number of children reported by the mother, calendar year of birth and asthma status in the child at age 10. To investigate systematically deviations between self-reported birthweight and birthweight in MBRN we made graphs of paired differences against the number of recall years and a Bland-Altman plot , which pSTATA , version IC 14.0 was used in all analyses.The study population comprised 1629 children of 715 mothers successfully matched with the MBRN . There wValidated against the Medical Birth Registry of Norway , gender When stratifying by asthma in the child as reported by the mother, no differences in validity of the maternally reported birth characteristics could be identified , nor didAmong the 1464 children with valid information on birthweight in both the questionnaire and the MBRN the correlation between mother’s reported birthweight and birthweight in the MBRN was 0.95 . The meaThe paired difference between reported and registry birthweight data did not change markedly with an increasing number of recall years , and theThe Bland-Altman plot in For 81% of the children, mother’s recalled birthweight was within ± 0.1 kg from the birthweight recorded in the registry, and for 90% reported birthweight was within 0.2 kg of recorded birthweight .In this study of maternally reported birth and pregnancy characteristics in a population based questionnaire study as validated against the Medical Birth Registry of Norway, we found very good agreement for the important variables: Gender, birthweight, instrumental delivery and caesarean section. We also found good agreement for preterm birth, and moderate agreement for induction of labour. The agreement was poor for the reporting of postterm delivery. While the sensitivity varied, the specificity of all maternally recorded variables was very high. The recall of birthweight was independent of time since delivery, even for deliveries almost fifty years ago. Validity of maternally recorded low birthweight and pre-term birth did not differ by the child’s asthma status, and risk associations of low birthweight and preterm birth with asthma in the child were similar for maternally recorded and registry recorded data.Birthweight is an important parameter in studies of early life events and impact on future health and disease. We found a very good agreement in reported birthweight, with 81% of recalled birthweight within ± 100 g compared to registry data, and 90% within ± 200 g. In a Danish study, Adegboye and Heitmann also reported good agreement concerning birthweight in a group of children aged 8–18 years n = 1428) . They fo28 . TheyPreterm birth is another variable of considerable interest. In our study the agreement for births before 32 weeks of gestation was better than that for births before week 37. Birth before week 32 implies that the newborn has to stay for a period in the neonatal intensive care unit, which is likely to be remembered by the parents. Extreme prematurity has the heaviest impact on future health, and thus, correct reports about this variable is important for research on this vulnerable group. The above mentioned study from Australia showed a 90% agreement (kappa 0.52) for live birth with gestational age less than 37 weeks, which is lower than in our study . A FrencThere is currently a considerable interest in postterm delivery related to the discussion of the optimal timing of inducing labour. Ours is one of the few studies investigating the validity of recalled postterm delivery. Unfortunately, our analyses showed poor agreement between maternal recall and MBRN data for this parameter. Of 237 deliveries reported to be postterm, only 103 (43%) occurred at 42 weeks of gestation or later, thus, according to the MBRN the remaining 134 were misclassified. Eight of the deliveries reported as postterm took place before 40 weeks (week 37–39) while the majority took place in week 40 , and in week 41 . Thus, most of the misclassified births reported to be postterm, took place after the term date, but not from week 42 or later as defined by the WHO as postterm. In our study population there appears to be a prevalent misconception regarding the definition of postterm birth. Our findings are in contradiction to findings in a Danish study showing that 85% of the morthers correctly reported postterm pregnancies .For 85 of 1714 children reported by the mothers, data were not found in the birth registry. There are several possible reasons for non-match: The mothers were asked to include stillbirths and may have included spontaneous abortions before week 16 which are not included in the MBRN. Children born outside of Norway would not be included in the MBRN. The mother could have reported the wrong birth year or her handwriting could have been misinterpreted by the technician who transferred the data from the questionnaires to the database. It is unlikely that non-match would be of notable importance for the results on validity and risk-associations in our study.In conclusion, maternally reported pregnancy and birth characteristics seem to be valid, even if the birth took place many years back in time and independent of the child’s disease status (exemplified with the child’s asthma status). The only exception was the reporting of postterm birth which was poor, mostly likely due to the discrepancy between the medical definition and the perception in the general public in this study population. Assessing birth and pregnancy data information from maternal reports, which is a feasible and cheap method, appears to be a useful method of high validity for several important birth and pregnancy parameters.S1 Table(DOCX)Click here for additional data file.


It is estimated to occur in 25–50% of preterm births and 20% of full-term births,2.5 exposures during and just prior to pregnancy, the team used historical data from 13 air quality monitors located throughout Massachusetts. And to assess IUI, they relied on both fever during labor and placental pathology.The researchers analyzed more than 5,000 mother–child pairs who were part of the larger Boston Birth Cohort. The births occurred at Boston Medical Center between 1999 and 2012. To estimate the women’s daily PM2.5 exposure and incidence of IUI for each trimester. Exposures estimated to have occurred during the first trimester were the most strongly associated with IUI at birth. The women with the highest exposures during this period were nearly twice as likely as the least-exposed women to exhibit IUI months later at birth—even though fewer than one-third of the women are thought to have ever seen PM2.5 levels exceeding the federal annual standard.The results showed a positive association between PM2.5 and low birth weight and preterm birth. “I think what we really need is more intermediate biomarkers, and that’s what this group did. These are the kinds of biological links that we need in the field to really get this confirmed,” says Ritz, who was not associated with the study. “This is a step forward toward a biological pathway, and inflammation is certainly a very logical one.”Beate Ritz, a researcher and professor of epidemiology at the University of California, Los Angeles, says the new findings suggest causation in the somewhat murky relationship between PM2.5. Nonetheless, the results may be useful for identifying times in pregnancy for more intensive follow-up in a future clinical study.The researchers could not tell whether IUI observed at birth had originated early in the pregnancy, within the last week, or somewhere in between. So it is still too soon to consider IUI a sensitive biomarker for assessing early biological effects of PMMariana Matera Veras, an experimental researcher in air pollution at the University of São Paolo, who also was not involved with the study, agrees that further studies are needed to evaluate the progression of IUI during pregnancy. She praises the authors for taking pregestational exposures into account and reiterates that IUI was seen in association with exposures that were below the accepted limits. “I think ‘safe’ levels of air pollution do not exist,” she says.The study also calls attention to the placenta as a potential source of epidemiological data, says coauthor Xiaobin Wang, director of the Center on Early Life Origins of Disease at the Johns Hopkins University Bloomberg School of Public Health. “The placenta is such a vital organ,” she says, yet researchers traditionally have not had access to it. “This often-discarded organ may have some real value in assessing early health effect of environmental exposure.”2.5 intake and IUI onset: “It doesn’t completely tell us how this is occurring,” notes Wills-Karp. “To do more mechanistic studies, we’d have to obtain live tissue by culturing placenta cells rather than simply examining pathology slides.”Granted, in this case there’s a limit to what placental pathology can reveal about PM


The recent prevalence of obesity in Japanese children is much higher compared to 1980. The present study compared daily sedentary behavior (SB) and physical activity (PA) between the school year and summer vacation in Japanese primary school children.Participants were 98 Japanese boys (8.9 ± 1.8 years at baseline) and 111 girls (9.1 ± 1.8 years). SB and PA were measured in May (school term) and July/August (summer vacation), 2011. SB and PA were assessed using a triaxial accelerometer  for 7 consecutive days. The average number of minutes spent in SB ), light intensity activity  and moderate-to-vigorous physical activity , and step counts were calculated for each individual. Moreover, the determinants/moderators of changes in SB and PA were examined.p < 0.05). Ambulatory and total LPA and MVPA, non-ambulatory LPA and step counts were lower in summer vacation in both genders (p < 0.001). Moreover, non-ambulatory MVPA was significantly lower in the summer vacation than in the school year for girls (p < 0.001). The decrease in non-ambulatory MVPA in boys and increase in SB in girls were significantly lower in those who participated in sports compared to those who did not (p < 0.040 or p < 0.033). The change in SB for boys was significantly associated with having a TV in the bedroom (p < 0.022).Daily SB was significantly higher in the summer vacation than in the school year for both boys and girls  contains supplementary material, which is available to authorized users. The recent prevalence of obesity in Japanese children is much higher compared to 1980 , 3. A maSB is distinct from PA –11, and Our convenience sample included 209 Japanese primary children from 4 public primary schools in urban areas in Tokyo and Kyoto. Participants were invited to participate by leaflets, such as a newsletter, at their school. Informed consent was obtained from all participants and their parents, and the Ethical Committee of J. F. Oberlin University approved the study protocol (No. 10007). Baseline data of anthropometric measurements, SB and PA were collected in May 2011 during the school year. The average temperatures in the school period and summer vacation were 19.3 (standard deviation (SD) 2.4) degrees and 27.3 (SD 2.5) degrees, the maximum temperatures were 24.5 (SD 3.8) degrees and 31.6 (SD 3.3) degrees, and the average humidities were 59.9 (SD 12.0) % and 68.7 (SD 6.3) %. All temperature and humidity data in summer vacation were higher than those of the school term in spring / standard weight for gender, age, and height (kg) × 100 (%)※ standard weight for gender, age, and height (kg) = a × measured height (cm) – ba and b are gender- and age-specific.The cut-offs of weight status are as follows: Overweight/ Obesity combined: ≥ + 120 %, Normal weight: −120 + 120 % and Thinness: ≤ − 120 %.The time spent at SB and each PA intensity per day was calculated by METs: average number of weekday and weekend minutes spent in SB (METs ≤ 1.5), LPA (1.5 < METs < 3.0), MVPA (3.0 ≤ METs), moderate PA (MPA) (3.0 ≤ METs <5.9) were calculated for each individual, and then average weekly values were calculated. For the data in the school year, average values were calculated by weighting for 5 weekdays and 2 weekend days (Weighted data = (average for weekdays × 5) + (average for weekend days × 2) / 7). The PA assessed by the accelerometer is presented as: (1) ambulatory activity or non-ambulatory activity in each intensity category ; and (2) number of steps registered per day. Values of SB and PA were adjusted by baseline and follow-up wear time, respectively.n = 46], no accelerometer data at baseline or follow-up [n = 94], no height/weight data at follow-up [n = 7]), our longitudinal sample comprised data from 209 children. A few questions weren’t answered completely by children or parents. Therefore, there were missing data in the analysis of the determinants/moderators of objectively measured changes in SB and PA. Numbers of each analysis were described in each Table. There was no significant difference between the relative weight at baseline of the participants and children who dropped out . The follow-up data were collected at the end of July or middle of August during the summer vacation  days).The initial sample comprised 356 participants. Due to missing data  adjusted for school, follow-up period, age, SB or PA at baseline. Moreover, when each first analysis was signifıcant, in the fınal stage of the analysis, SB or PA variables were also adjusted in the same model. When the number of each answer was below 10 participants, the category was added to the next other category. Results are shown as means ± SD. Statistical analysis was performed with IBM SPSS statistics 20.0 for Windows . The characteristics of study participants are presented in Table Time spent at different activity intensity levels for ambulatory and non-ambulatory activity and total time, and step counts are shown in Table The decrease in non-ambulatory MVPA was significantly lower for boys who participated in sports, both for the school periods and summer vacation, than those who did not Table . The incThe perception of sports and body image by boys, health perception by boys’ parents, activity and sports perceptions by girls, and the sports perceptions and body image by girls’ parents were associated with change in SB and PAs, respectively (see attached Additional files This study examined the longitudinal changes of objectively evaluated SB and PA, between the school year and summer vacation in Japanese primary school children. To our knowledge, no previous study has addressed changes in objectively-evaluated sedentary time and physically activity with discrimination between ambulatory and non-ambulatory PA in elementary school children at the school year and summer vacation. As we hypothesized, SB increased and PA decreased significantly in the summer vacation in both genders. Adverse changes in the summer vacation were moderated by membership of sports clubs, not having a TV in the bedroom, positive perceptions of sports for boys or positive perceptions of sports and activity for girls and their parents and negative perception of boy’s health for their parents. In detail, there were significant decreases in ambulatory and total LPA, MVPA, MPA and step counts in the summer vacation in both genders, while non-ambulatory MVPA and MPA were significantly lower in the summer vacation just in girls.A previous review  describeThere appears to be even less comparable literature on the determinants or moderators of seasonal changes in PA and SB in children. Rowlands et al.  considerThe present study suggested a possible gender difference in the determinants/moderators of seasonal changes in PA and SB. For boys, participation in sports, not having a television set in the boy’s bedroom, positive perceptions of sports by themselves and the negative perceptions of child’s health by their parents might be better targets for intervention for boy’s SB and non-ambulatory and ambulatory PAs. In the case of girls, participation in sports, the positive perceptions of or highly perceived competence in sports or activity by themselves or their parents and the negative perceptions of child’s body by their parents might be important for girls’ SB and PA changes in the summer vacation. Recent reviews reported that sport participants have more PA than those who do not participate and higher engagement with sport and PA can lead to improvements in self-esteem, at least in the short term , 32. MorThere were several limitations to the current study. The accelerometer used in the present study has been validated and has been widely used to evaluate PA in Japan, but may not accurately assess all types of PA, such as swimming, cycling and bathing. Nixon et al.  reportedThese present study suggests that Japanese primary school children of both genders have higher SB and lower LPA and ambulatory MVPA during the summer vacation. The results emphasize the need to take summer vacation into account when developing PA or SB interventions for primary school children in Japan. This study also suggests some factors that may moderate seasonal changes in PA and SB in Japanese children: sports participation may mitigate the adverse changes for boys and girls; television in the bedroom may exacerbate the seasonal change.