Both air pollution exposure and socioeconomic status (SES) are important indicators of children’s health. Using highly resolved modeled predictive surfaces, we examine the joint effects of air pollution exposure and measures of SES in a population level analysis of pregnancy outcomes in North Carolina (NC).2.5) and ozone (O3) were calculated through a spatial hierarchical Bayesian model which produces census-tract level point predictions. Using multilevel models and NC birth data from 2002–2006, we examine the association between pregnancy averaged PM2.5 and O3, individual and area-based SES indicators, and birth outcomes.Daily measurements of particulate matter <2.5 μm in aerodynamic diameter  highly resolved air pollution exposure data; 2) a five-year population level sample of pregnancies; and 3) including personal and areal level measures of social determinants of pregnancy outcomes. Results show a stable and negative association between air pollution exposure and adverse birth outcomes. Additionally, the more socially disadvantaged populations are at a greater risk; controlling for both SES and environmental stressors provides a better understanding of the contributing factors to poor children’s health outcomes. Both air pollution exposure and socioeconomic status (SES) are important indicators of health, and particularly children’s health. Studies have shown that adverse birth outcomes including low birth weight , small for gestational age , or preterm birth  have been associated with lower SES -9.2.5) [Environmental pollutants can have a disparate effect among economically disadvantaged and minority populations . Studies2.5) . Studies2.5) ,11.Air pollution exposure has also been associated with adverse birth outcomes for both NHB and NHW women ,16,17. REvidence has shown that there exists a relationship between SES and pregnancy outcomes ,23,28,29As exact measures of personal air pollution exposure are both difficult and expensive to obtain, health studies often use measurements obtained from monitoring stations as surrogates for individual exposure assessment ,5. These3 and PM2.5 to get daily concentration estimates at the census-tract level. This highly spatially resolved concentration metric is available for the entire state of NC, which allows us to include women that would typically be excluded from analyses that use only monitoring networks as exposure surrogates. We obtain personal data from the North Carolina Detailed Birth Records (NCDBR) and neighborhood SES data from the US Census. We use both individual- and area-level measures of SES to capture the effects of the individual SES measures, as well as any additional residual area-level effects that may exist.Our objective was to conduct a population level study of all pregnancies in North Carolina (NC) over a five-year period focusing on the effects of SES and air pollution. We assess the relationship between birth weight (BWT), LBW, SGA, and PTB and modeled air pollution measures. We use modeled predictive surfaces of ONCDBR data were obtained from the North Carolina State Center for Health Statistics for the years 2002–2006. The NCDBR contains birth outcomes, as well as maternal characteristics and demographics, for all registered live births in NC . Infant characteristics obtained from the birth records included clinical estimate of gestational age (weeks), infant sex, BWT, indication of congenital anomalies, plurality, and date of birth. The maternal characteristics recorded in the NCDBR included residential address at time of birth, age, marital status, education, race and ethnicity, tobacco use, parity, and the trimester in which prenatal care began.To link births from the NCDBR to the air pollution data, we used ArcGIS 9.3 software to geocode individual maternal residential street addresses at the street block level . Approximately 14% of the total births could not be successfully geocoded due to poor address information and were omitted from further analyses. We excluded multiple births (3.4%), and infants with diagnosed congenital anomalies at the time of birth (0.8%). These exclusions were chosen as we sought to focus on those pregnancies that could reasonably be expected to go to term and deliver at a normal BWT. We also excluded women < 15 and > 44 years of age (0.3%) with more than 4 previous deliveries (3.8%). Since 96% of the women in the dataset self-declared as NHW, NHB, or Hispanic, we excluded women of other races/ethnicities due to the small numbers in other minority groups. We excluded births with gestation < 24 and > 42 weeks (0.1%), BWT < 400g (0.2%), and mothers with any missing data on covariates (1.0%), leaving 457,642 births. This study was conducted in accordance with a human subjects research protocol approved by the Duke University and University of Michigan Institutional Review Boards.2.5 (daily average in μg/m3) and O3 (daily 8-hr maximum in ppb) surfaces were obtained at the census tract level for the entire State of NC. Archived daily downscaler surfaces for 2001–2008 are available at: http://www.epa.gov/esd/land-sci/lcb/lcb_faqsd.html. The downscaling fusion model uses input data from two sources: (1) monitoring networks and (2) numerical models. The air quality monitoring data came from the US Environmental Protection Agency Air Quality System repository database, and the numerical output came from the Models-3/Community Multiscale Air Quality . Further details and descriptions of the modeling approach can be found in Berrocal et al. [Air pollution data from 2001–2006 were used as surrogate exposure measurements for this study, as exposure during pregnancy for some births in 2002 began in 2001. Using a Bayesian space-time downscaling fusion model, daily predicted PMl et al. .To estimate air pollution exposure, we linked births to the census tract corresponding to each mother’s residence at the time of delivery. The time period of exposure for each birth was calculated using the date of birth and the weeks of gestation at delivery, as recorded in the NCDBR. Using daily estimated pollution levels from the fused data, we calculated average exposure for the entire pregnancy. The high spatial and temporal resolution of the fused data provides exposure estimates for all of the successfully geocoded birth records, with no missing values for any days during the exposure window.We use individual measures of SES from the NCDBR and an areal measure of household median income from the 2000 US Census. The size of census tracts in North Carolina ranges from 0.4 to 3529.6 sq km with a mean of 87.8 and a standard deviation (SD) of 171.3. Population density ranged from 2 to 4380 people per sq km with a mean of 442 and SD of 550. From the NCDBR, maternal education was categorized by years of completion as < 9 (middle school), 9–11 (some high school), 12 (completed high school), 13–15 (some college), and > 15 years (completed college). We categorized the census tract-level household median income into tertiles as low, moderate, and high.3 and PM2.5, and an array of pregnancy outcomes. Using BWT (g) as a continuous outcome variable, we examined the effect of average O3 and PM2.5 over the entire pregnancy while controlling for gestational age , maternal race/ethnicity , maternal education, maternal age at delivery , trimester prenatal care began, tobacco use during pregnancy (yes or no), marital status at delivery (married or unmarried), year of birth, parity , infant sex, and census tract-level median household income. We also examined the effects of air pollution exposure on the binary outcomes of LBW, SGA, and PTB. SGA was calculated by comparing each record’s birth weight and gestation age to a sex-specific, national reference distribution of birth weights for a given gestational age at delivery. Census tracts were specified as a random effect to account for neighborhood level correlation. Analyses were performed using SAS 9.3 .Linear and logistic mixed regression modeling were used to determine the association between exposure to the pollutants of interest, OOur analysis included 457,642 births after the exclusion criteria were applied. In the study population, 7.3% of births were LBW, 10.2% were SGA, and 9.8% were PTB. Table Among births incurring a poor birth outcome, the proportion of births to mothers who were NHB and living in low household median income census tracts were greater than in the overall population of women. The largest difference between the demographic composition of the overall population and among births with adverse outcomes was seen among LBW births, where the proportion of NHB mothers rises from 23% in the general population to 50% among LBW births. Higher rates of firstborn births, women receiving no prenatal care, those who smoked during pregnancy, and mothers with lower educational attainment, all characteristics associated with poor birth outcomes, were seen among the poor birth outcomes subgroups compared to all births Table .2.5 and O3 concentrations during pregnancy as the overall study population (Table 2.5 and O3 remain relatively consistent across race/ethnicity and the SES variables (results not shown). We observe a pairwise statistically significant relationship among the race/ethnicity, maternal education, and household median income variables, with p<.0001 (data not shown).Women with adverse birth outcomes had similar mean PMon Table . Mean ai2.5 exposure and birth outcomes. NHB and Hispanic mothers were more likely to have infants born with lower birth weight when compared with NHW mothers . Infants born to NHB mothers were also at an increased odds of being born LBW , PTB , and SGA . In models for all outcomes, highly educated mothers and those living in high SES neighborhoods had better birth outcomes compared to mothers with only a high school level education and those living in moderate income neighborhoods  and 95% confidence intervals (CI) for all birth outcomes. Table 2.5 was associated with a small but significant reduction in BWT. An inter-quartile range (IQR) increase in PM2.5 during the entire gestational period reduced BWT by 3.1 g (95% CI: 3.0 to 3.2). An IQR increase in maternal exposure to PM2.5 was significantly associated with increased odds of being SGA , but not LBW or PTB.For the continuous BWT models, PM3 exposure and birth outcomes. Race and SES followed similar patterns to those seen in the PM2.5 models. NHB and Hispanic mothers were more likely to have infants born with lower birth weight when compared with NHW mothers . Infants born to NHB mothers were also at increased odds of being born LBW , PTB , and SGA . Across all models, highly educated mothers and those living in census tracts with high household median income had better birth outcomes when compared to mothers with only a high school level education and those living in moderate income neighborhoods . Additionally, an IQR increase in maternal exposure to O3 was significantly associated with increased odds of being SGA  and LBW , but not PTB.Comparable to the PMSensitivity analyses controlling for seasonality did not reveal season to be an important predictor of outcomes. Models adjusting for urban and rural indicators also did not modify the reported results. Interaction terms of SES and air pollution did not produce significant results for any of the adverse birth outcomes.2.5 and O3 and measures of SES on birth outcomes in NC. Our results indicate that both O3 and PM2.5 are associated with adverse birth outcomes, specifically LBW and SGA. As expected, individual and neighborhood SES also contribute to adverse birth outcomes. We found that NHB mothers and women with lower educational attainment were generally at an increased risk of having a poor birth outcome when compared to NHW mother and those with higher levels of education. Mothers living in census tracts with lower household median income were also at an increased risk of adverse pregnancy outcomes. Air pollution exposure contributed an additional harmful effect on pregnancy after controlling for race and individual and area-level SES.We examined the effects of maternal exposure to PM2.5 are consistent with previous studies [2.5 during the entire pregnancy. In contrast to our study results, Bell et al. also showed increased odds of being born LBW for PM2.5. Gray et al. [2.5.Our findings on the association between adverse birth outcomes and PM studies ,5,20. Us studies  showed r3, and fewer still have found a consistent and significant relationship with adverse pregnancy outcomes [3 during the entire gestational period [3 and BWT in a California study. Liu et al. [3 and PTB or LBW in Vancouver, Canada.While a number of studies have examined the relationship between particulate matter and pregnancy, fewer studies have focused on Ooutcomes ,38,39. Al period . Salam el period  showed su et al.  found no3 and PM2.5 are not explicit measures of maternal exposure to pollution, as they do not take into account daily activity patterns, indoor sources, or ventilation conditions. We also used maternal address at the time of delivery, which may not necessarily be the address during the entire pregnancy. Data on residential mobility were not available for this study. These results may also be affected by residual confounding as there are several other factors we were unable to control for that can contribute to pregnancy outcomes, including access to healthcare, pre-pregnancy weight, maternal height, and nutrition.This study is not without limitations. We acknowledge that the modeled concentration data for OOne of the key strengths of this study is the availability of exposure data for the entire State of NC with no missing days of exposure data. In environmental health studies, air pollution measurements from a sparse network of monitoring stations or proximity to major roadways are commonly used as a proxy for personal exposure. The fine spatial and temporal resolution of the modeled air pollution data allowed us to obtain estimates for times and locations where exposure data are not otherwise available. With air pollution estimates for the entire state, the analyses were performed at the population level rather than in a non-randomly restricted subset of the population based on proximity to environmental hazards or monitoring stations.2.5 and O3.Previous studies have used hierarchical models to examine the relationship between individual and local SES, pollution, and adverse birth outcomes, but many focus on traffic-related pollution, proximity to highways, lead, or sulfur dioxide ,19,42,433 affected both lung function and reproductive outcomes in the offspring [3 exposure was associated with decreases in the number of viable pregnancies and the body weight in the surviving offspring [The biological mechanisms through which air pollution may affect pregnancy are still unclear. Air pollution may affect birth outcomes through multiple pathways including oxidative stress, blood flow, placental formation and function, and inflammatory responses . Additioffspring . Increasffspring . More woThis study on infant health uses modeled state-wide measurements of air pollution along with individual and neighborhood SES in a hierarchical model on pregnancy outcomes. Our results show that despite NC’s consistent attainment of federal air quality standards, there is a stable and negative association between air pollution exposure and adverse birth outcomes. Additionally, the more socially disadvantaged populations are at a greater risk, and controlling for both SES and environmental stressors provides a better understanding of the factors contributing to reproductive health.BWT: Birth weight; CI: Confidence interval; CMAQ: Community Multi-Scale Air Quality Model; IUGR: Intrauterine growth restriction; LBW: Low birth weigh; NC: North Carolina; NCDBR: North Carolina Detailed Birth Records; NHB: Non-Hispanic Black; NHW: Non-Hispanic White; O3: Ozone; OR: Odds ratio; pCNEM: Probabilistic NAAQS Exposure Model; PM2.5: Particulate matter <2.5 μm in aerodynamic diameter; PTB: Preterm birth; SES: Socioeconomic status; SGA: Small for gestational age; SHEDS-PM: Stochastic human exposure and dose simulation model.The authors declare that they have no competing interests.SCG participated in the original study design, carried out the primary data analysis, and prepared the first draft of the manuscript. SEE coordinated the data collection and participated in the manuscript preparation. BDS and MLM made substantial contributions to the design and direction of the study. All authors assisted with drafting and revising the manuscript. All authors have read and approved the final manuscript.


Malaria remains a major public health problem in sub Saharan Africa and the extent of utilisation of malaria preventive measures may impact on the burden of malaria in pregnancy. This study sought to determine the association between malaria preventive measures utilized during pregnancy and the birth outcomes of birth weight and preterm delivery.This cross sectional survey involved 800 mothers who delivered at the University College Hospital, and Adeoyo Maternity Hospital, Ibadan. Data obtained included obstetric information, gestational age, birth weight and self reported use of malaria prevention strategies in index pregnancy.Most (95.6%) mothers used one or more malaria control measures. The most commonly used vector control measures were window net (84.0%), insecticide spray (71.5%) and insecticide treated bed nets (20.1%), while chemoprophylactic agents were pyrimethamine (23.5%), Intermittent Preventive Treatments with Sulphadoxine-Pyrimethamine (IPTsp) (18.5%) and intermittent chloroquine (9.5%) and 21.7% used herbal medications. The mean ± SD birthweight and gestational age of the babies were 3.02 kg ± 0.56 and 37.9 weeks ± 2.5 respectively. Preterm delivery rate was 19.4% and 9% had low birth weight.Comparing babies whose mothers had IPTsp with those who did not, mean birth weight was 3.13 kg ± 0.52 versus 3.0 kg ± 0.56 (p = 0.016) and mean gestational age was 38.5 weeks ± 2.1 versus 37.8 weeks ± 2.5 (p = 0.002).The non-use of IPTsp was associated with increased risk of having low birth weight babies  and preterm birth . The non use of herbal preparations  was associated with reduced risk of preterm birth. The mean ± SD birth weight and gestational ages of babies born to mothers who slept under ITNs were not significantly different from those who did not (p = 0.07 and 0.09 respectively).There is a need for improved utilisation of IPTsp as well as discouraging the use of herbal medications in pregnancy in order to reduce pregnancy outcome measures of low birth weight and preterm deliveries in this environment. The burden of malaria in pregnancy (MIP) remains high in endemic areas, where despite considerable immunity, pregnant women continue to have symptomatic and asymptomatic parasitaemia resulting in adverse pregnancy outcomes. The relationship between malaria and neonatal morbidity in endemic areas such as Nigeria continues to be a subject of research. Malaria in pregnancy has been associated with significant degree of intrauterine growth restriction, 36% of preterm deliveries, 30% of preventable low birth weight deliveries, 14% of low birth weight deliveries and 15% of maternal anaemia , abortioThe World Health Organisation recommends the use of intermittent presumptive treatment with sulphadoxine pyrimethamine (IPTsp), household use of insecticide-treated bednets (ITNs) and effective and prompt case management as malaria control strategies in pregnancy . Other mThis is a cross sectional analytical study involving 800 mothers who delivered at the labour ward of the University College Hospital (UCH) and Adeoyo Maternity Hospital (AMH), Ibadan, Nigeria over a 3 month period . The UCH is a tertiary health facility while AMH provides secondary health care in the same Ibadan North local government area, South-West of Nigeria. The two hospitals are the government-owned birth centres in the locality. ITN and IPTsp were not routinely provided free of charge at the two centres during the study period. However, there was a standard national protocol for prescribing IPTsp in place.It was estimated that enrolling 733 women out of the anticipated 2000 deliveries in the two hospitals during the study period at an assumed low birthweight delivery rate of 14%  would gThe participants were recruited consecutively during week-days at delivery and interviewed (by trained assistants) with the aid of a pretested semi-structured questionnaire within 24 hours of birth. Informed consent was obtained after explaining the study. Mothers were approached on the lying-in wards and those who declined enrolment or who delivered on weekends and had been discharged before Monday were excluded from the study. Information on maternal age, education, pregnancy history, gestational ages of babies and self reported use of 2 doses of sulfadoxine-pyrimethamine, pyrimethamine, chloroquine and herbal preparations in index pregnancy was obtained. Other data obtained included use of vector control measures such as insecticide treated bednets, insecticide spray, mosquito coils and window nets. Birth weights were recorded to the nearest 50 g using SECA weighing scales  while gestational age was obtained through mothers' last menstrual period or Ballard scores when mothers dates were uncertain and there were no early ultrasound scans available. By convention, babies born before 37 completed weeks of gestation were regarded as preterm and those weighing less than 2500 g, low birth weight. Social class stratification was based on the Oyedeji classification which is derived from the level of education and present occupation . Classesp value less than 0.05 was considered statistically significant.Data were recorded and analyzed with SPSS version 11 . Descriptive statistics were done for all variables and also used to assess associations between pregnancy outcomes (preterm delivery and low birth weight) and malarial control measures. After the univariable analysis, multivariable logistic regression was used to further examine the association between each MIP used and outcome while controlling for the others. Effects of malaria control measures on pregnancy outcomes were presented as odds ratio (OR) and 95% Confidence interval. A Ethical approval was obtained from the University of Ibadan/University College Hospital ethical review committee.There were a total of 1220 deliveries at Adeoyo maternity and UCH during the study period. Eight hundred mothers were interviewed but 4 had incomplete data and were excluded from analysis. Of the 796 analysed, 475 (59.7%) were from Adeoyo Maternity Hospital and 321 (40.3%) from UCH. The mothers were aged between 18 and 46 years with mean (SD) of 29.4 years (5.1). Most (86.1%) were aged between 21 and 35 years while 3.3% and 10.6% were aged < 21 years and > 35 years respectively. Almost all (96.3%) were married. The majority of the mothers (78.3%) had up to 12 years of formal education, while 19.2% had less than 12 years and only 2.5% had no formal education. Other demographic characteristics are shown in table The mean (SD) birthweight was 3.02 kg (0.56) and mean (SD) gestational age was 37.9 weeks (2.5). About 19.4% were preterm and 80.7% were full term; the low birthweight rate was 9.0%. Table Majority (95.6%) of the mothers used one or more malaria preventive measures. The most commonly used measures were window nets 84.0%), insecticide sprays (71.5%) and insecticide treated bednets (20.1%). Common chemoprophylactic agents included pyrimethamine 23.5%) and IPTsp (18.5%), while 21.7% of the mothers used traditional herbal medications. Other measures employed are shown in Table .5% and I.0%, inseA higher proportion of mothers from the upper social classes (1 and 2) utilized effective malaria preventive measures i.e. bed nets (39.1 - 43.8%), ITN (25 - 30.2%), IPTsp (20.3 - 31.4%) than mothers in the lower classes (3 - 5), , whereas, the use of herbal medications was more preponderant among those in the lower social classes (31.8 - 34.1% vs 6.5 - 12.0%).The comparison of birthweight and gestational age by malaria preventive measures utilised by participants is shown in Table Mothers who reported non-usage of IPTsp had significantly higher rates of LBW and preterm births, while users of weekly pyrimethamine and traditional herbs had higher rates of preterm births. However, on multivariable analysis, non-users of IPTsp were 2 times more likely to have LBW babies  and preterm birth , while non-use of herbal medications was associated with reduced risk of preterm birth  Table Our study showed that despite the institution of IPTsp and ITN as the national policy on MIP, only 20% uptake of ITN and 18.5% for IPTsp was documented, with significant use of pyrimethamine monotherapy, and this uptake level is well below the expected target of over 50% in the Nigerian national policy on malaria prevention strategies document . The stuet al [The adverse consequences associated with MIP  underscoet al , and deset al [The LBW and preterm deliveries in this study, as in Dolan et al , were siet al . The preet al , and thaet al . This stThe mean birth weight was significantly higher and risk of preterm delivery reduced by half among those who did not use herbal preparations. Though the contents of the traditional medication consumed are unknown and these authors are unaware of previous documentation of the impact of traditional medications, this present study therefore highlights the need to discourage the use of traditional herbal medication through improved health education and promotion before and during pregnancy.et al [The financial burden of managing preterm, low birthweight deliveries in developing countries can be prohibitive compared with the cost of preventing these poor outcomes. Tongo et al  in IbadaThe study relied solely on self reported use of malaria preventive measures as indicator of utilization and this may have some limitations in the interpretation of the actual effects of these measures on pregnancy outcomes. Though the different social classes in the population were represented in this study, care has to be taken in extrapolating data to the whole population. The study excluded mothers who delivered on weekends, but it is not expected that the subjects' characteristics would differ whether they delivered on weekdays or weekends.Most pregnant mothers in this environment utilize malaria preventive measures. The utilization rates of IPTsp and ITN are still low while that of herbal medications is high with attendant increased risk of low birth weight and preterm births. There is a need to educate mothers on the proven benefits of IPTsp and ITN as well as ensure their availability in other to have improved pregnancy outcomes.The authors declare that they have no competing interests.OOT designed, conducted the study, drafted and revised the manuscript, AEO participated in the design, did data analysis and interpretation as well as revision of the manuscript, OOA conceived the study and participated in the design and revision of the manuscript. All authors have read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/11/60/prepub


Infant mortality accounts for almost 67 percent of under-five child mortality that occurs globally. An understanding of factors related to infant mortality is important to guide the development of focused and evidence-based health interventions to reduce infant deaths. But no community based studies have been conducted to identify determinants of infant mortality in Ethiopia for the past two decades. The purpose of this study is to identify determinants of infant mortality in community of Gilgel Gibe Field Research Center, Southwest Ethiopia.A community based matched case–control study was conducted. The study covered 133 infants who died during infancy between January 2010 and February 2011 in the study area. For each case, a control with approximately same date of birth and survived his/her first year of live and alive at time data collection was selected. Conditional logistic regression method was used to identify determinant factors of infant mortality using Epi-info 3.5.1 statistical software.According to the final logistic regression model, not attending antenatal care follow-up , not using soap for hand washing before feeding child , negative perceived benefits of mother to modern treatment and prevention , small birth size  and high birth order with short birth interval  were found to be independent determinants of infant mortality.Antenatal care follow-up, hand washing habit with soap before feeding child, birth size, perceived benefits of mothers to modern treatment, birth order and preceding birth interval were determinants of infant mortality. Infant mortality rate is defined as the risk for a live-born child to die before its first birthday. Infant mortality is known to be one of the most sensitive and commonly used indicators of the socioeconomic and health status of a country -3. More The conceptual framework for study of determinants of child survival includes proximate and distal (socioeconomic) determinants. This approach to the study of child survival is based on several premises . Differeth in the world by total number of death of infants  setting was identified by Jimma University as a field research center and setting for Community Based Education. There are eight rural and two urban kebeles in the area. In 2011, the total population of the study area was about 50,000 within 10,500 households. According to GGFRC record 2,120 infants were born alive in the study area from January 1, 2010 to February 29, 2011. The study population included all cases identified and their controls registered in the research center database. Cases were all infants who were born alive from January 1, 2010 to February 29, 2011 and died before celebrating their first birth day. For each case, a control with date of birth within two days and alive at time of data collection was selected.The number of cases and controls required for the study were determined using sample size formula for matched case–control studies .Wherem = numbers of discordant pairsn = sample size in pairsψ = = Odd ratio calculated by [p1(1-p2)]/[p2(1-p1)], where p1 and p2 are the exposure rate of the case and control groups.Pd = the proportion of discordant pairs, = p2q1+p1q2α = value of standard normal distribution corresponding to a significance level of alphaΖβ = value of standard normal distribution corresponding to the desired level of power of the testΖAs estimated from study done in Iran, proportion of mother’s age at first birth less than 18 years (main exposure variable) among the cases and controls are 47.8% and 33.7% respectively (28). At 5% level of significance, power of 90% and non-response rate of 5%, the number of cases and controls required were 266 (133 cases and 133 controls).Data were collected from mothers via face to face interview using structured questionnaire adapted from another study . Socio-eWealth score index was measured based on six dimensions: income greater than 500 Ethiopian Birr per month, presence of radio or television, availability of latrine, safe water supply and roof of house made of corrugated iron sheets were given score one and other categories were given score 0. The sum was computed and respondents who scored above the mean were labeled as satisfied basic need and otherwise labeled as poor. Eight knowledge questions on common cause of infant morbidity and mortality and its prevention were presented and correct answer scored 1 and incorrect answer score 0. The sum was computed and those who got above the mean were labeled as having ‘good knowledge’ otherwise poor knowledge.Perceived severity of common diseases, perceived susceptibility of child to common diseases, perceived benefits and barriers of common prevention methods were assessed using Likert Scale Method . Mean scores for each construct was computed and dichotomized into positive and negative. If a respondent scores below the mean she was labeled as having positive perceived severity, susceptibility, benefits and barriers, otherwise negative. Four questions related to practice were asked. These questions were related to breast milk, complementary feeding, Oral Rehydration Salt (ORS), use of Insecticide Treated bed Nets (ITN) and place of treatments when a child is sick. Correct answer scored 1 and incorrect answer scored 0. The sum was computed and those scoring above the mean were labeled as having good practice otherwise poor. Birth size is size of child at birth, which is considered as a proxy of birth weight, based on perception of the mother.Data were entered, processed and analyzed by EPI INFO software version 3.5.1. Data analysis was started by describing each variables involved. Bivariate conditional logistic regression models were fitted for each explanatory variable separately to identify those associated with infant mortality. Variables with p-value less than 0.20 in the bivariate analysis were considered as candidate to be entered in the multivariate model. The using back ward elimination method the final model was fitted. Log likelihood ratio test was used to assess the goodness of fitness of the final model.The ethical clearance was obtained from Jimma University. Written informed consent was also obtained from each respondent.A total of 254 infants’ mothers were interviewed, having the response rate of 95.5%. All of the infants were singleton birth. Fifty-eight percent case infants were males. Almost 96% of the mother’s of both cases and controls were Oromo by their ethnicity. Ninety percents of mother’s of cases were illiterate. The mean (±SD) age of (mothers was 29.9(5.7) Table .Among 127 deaths included in the present study, 24 (18.9%), 29 (22.8%) and 74(58.3%) were died during the first 24 hours after birth, after 24hours to 28 days and during post-neonatal (29 to 364 days) respectively.The minimum and maximum household’s monthly income was 100 and 4500birr for cases and 100 and 6000birr for controls. The median monthly income was 350 birr for cases and 450 for controls. The mean (± SD) age of weaning by months among case and control were 4.5 (± 1.90) and 5.3 (± 1.40) respectively.During bivariate analysis, educational status of mother, wealth index, family size, lack of radio, ANC follow up, birth order with birth interval, birth size, immunization status of child, soap use for hand washing before feeding child, availability of latrine, type of roof, availability of windows, perceived benefits of mothers on modern treatments and prevention and good mother’s practice concerning breastfeeding, ORS use during diarrhea, ITN utilization and taking ill infants to health facility were significantly associated with infant mortality. However, other variables like educational status of father, occupation of mother, age of mother at childbirth, age at first marriage, age at first birth and place of delivery were not significantly associated Table .Finally, ANC follow up during pregnancy, size of child at birth, mother’s perceived benefits on modern treatment to common diseases, mothers hand washing with soap, birth order and birth interval were independent determinants of infant mortality Table .The study showed that, infants whose mothers had no ANC follow up were more likely to die than those whose mothers had at least one follow up . The risk of infant mortality among small size babies at birth were higher compared to those average and larger sized . Among infants whose birth order were two through four, the risk of dying were higher for those with preceding birth interval less than two years compared to those with more than or equal to two years of spacing . Compared to those who were born after more than or equal to two years of spacing and their birth order second to fourth, the risk of dying were 2.7 times higher among infants who were born after spacing of greater than or equal two years from the preceding birth and were fifth birth order or above . Hand washing with soap before feeding child was found to be significant in determining infant mortality. Infants whose mothers did not use soap for hand washing were more likely to die than whose mothers used soap . Of behavioral factors, perceived benefit of modern treatment of common diseases was found to be significant in determining infant mortality. The risks of dying among infants whose mothers had negative perceptions on modern treatment were higher compared to infants whose mothers had positive perceived benefits .This study intended to identify the determinants of infant mortality. The study use analytic matched case control design. However, it might have some limitation such as: first, recall bias on risk factors. Second, survivals of infants are related to the past whereas available measures of household income and mother knowledge are current measures. Therefore, in this study, current income is a proxy for the past year income and current knowledge is a proxy for the past year knowledge. Third, birth weight of infant was estimated by birth size as reported by mother, which is based on mother’s perception. Fourth, some variables like postnatal care, access to health care, maternal tetanus toxoid immunization status, nutritional status of mother during pregnancy, health status of mother during pregnancy and nutritional status of child were not explicitly assessed by this study. Therefore, any reader of this manuscript should take in to account the above limitations.The analysis of breast feeding was restricted to infants older than 7 days to avoid including neonatal deaths that were not likely related to infant feeding mode; to avoid reverse causation. It was hypothesized that the time when colostrums would start to provide protection to the infant is 7 days after birth . In thisIn this study, maternal education is found to be not associated with infant mortality. Similar studies done in Kenya, Pakistan and Iran also showed that no significant association between infant mortality and maternal education ,18,28. HConcerning maternal age at birth of the child, even though, it is in same direction with previous studies ,18,22,30Previous studies had reported significant association between fertility variable  and infant mortality ,18,28-30ANC follow-up was associated with infant mortality. Those infants whose mothers had no ANC follow-up during pregnancy had twice more likely to die than whose mothers had at least one follow-up. Similarly, studies done in southwest Ethiopia, Brazil and India showed that, there is association between ANC follow-up and infant mortality ,16,22. TSmall birth size was one of the determinants of infant mortality. This had been reported by previous studies done Ethiopia, Brazil and Indonesia ,16,31. BImmunization practice is directly related with health status of infant. Associations had been previously reported between immunization and the risks of infant mortality ,15,17,23In this study hand washing habit with soap before feeding child was significantly associated with infant mortality. Similar finding was reported by other study done previously in Southwest Ethiopia .Among behavioral factors, there was a significant association between negative perception on benefits of some modern treatment and infant mortality. This result is in line with study done previously on determinants of under-five mortality . This miThis study identified ANC follow up, birth size, hand washing habit of mothers with soap before preparation of food and feeding, perceived benefits of modern treatment, birth order and birth interval as a determinants of infant mortality. Therefore promoting antenatal care follow up for all pregnant women, reducing the higher birth order and prolonging short birth interval though family planning will have the substantial effect in reducing the risk of infant mortality. Secondly promotion of hand washing with soap while preparing food and infant feeding is also recommended. Thus, national public health intervention at primary health care level  to improve infant survival should focus on these determinants to reduce infant mortality. Additionally further study including the above missed variables is also recommended.The authors declare that they have no competing interests.LD involved from the inception to design, acquisition of data, analysis and interpretation, drafting the manuscript, MT involved in the inception to design, analysis and interpretation and revise critically the manuscript. HA involved in the inception to design, analysis and interpretation and revise and edit the manuscript for the final submission. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/13/401/prepub


Background: Perfluorooctanoic acid (PFOA) is a potential cause of adverse pregnancy outcomes, but previous studies have been limited by low exposures and small study size.Objectives: Using birth certificate information, we examined the relation between estimated PFOA exposure and birth outcomes in an area of West Virginia and Ohio whose drinking water was contaminated by a chemical plant.n = 106), pregnancy-induced hypertension (n = 224), preterm birth , term low birth weight (n = 918), term small-for-gestational-age (SGA) (n = 353), and a continuous measure of birth weight among a sample of term births . A 10% sample of term births ≥ 2,500 g were selected as a source of controls . Historical estimates of serum PFOA were derived from a previously developed fate and transport model. In a second study, we examined 4,547 area births linked to a survey with residential history data.Methods: Births in the study area from 1990 through 2004 were examined to generate case groups of stillbirth (Results: In the analysis based only on birth records, we found no consistent evidence of an association between estimated PFOA exposure and stillbirth, pregnancy-induced hypertension, preterm birth, or indices of fetal growth. In the analysis of birth records linked to the survey, PFOA was unrelated to pregnancy-induced hypertension or preterm birth but showed some suggestion of an association with early preterm birth. Measures of growth restriction showed weak and inconsistent associations with PFOA.Conclusions: Based on the analysis using the health survey, these results provide little support for an effect of PFOA exposure on most pregnancy outcomes, except for early preterm birth and possibly fetal growth restriction. Adverse effects of perfluorooctanoic acid (PFOA) and related perfluoroalkyl acids on pregnancy and development have been suggested based on toxicology  and a smA large population in Ohio and West Virginia has been exposed to PFOA predominantly through industrial contamination of drinking-water supplies . Within For participants in the C8 Health Project—a survey conducted in the contaminated region —we previThe study area in the mid-Ohio Valley was chosen to include PFOA-contaminated public water utilities in Mason and Wood counties in West Virginia and in Athens, Meigs, and Washington counties in Ohio, where levels ranged from near U.S. averages to orders of magnitude above typical levels . We obtan = 3,616) was selected and geocoded for assigning PFOA exposure.Because of the expense involved with refining address information and geocoding maternal residences, which is the basis for assigning exposure, we used case–control sampling to enhance precision for some of the birth outcomes of interest. We restricted eligibility to singleton births and excluded the small proportion (3%) of nonwhite births because there were too few to analyze separately. Comprehensively identified case groups consisted of stillbirths , preterm births (< 37 weeks completed gestation), and term low birth weight births . A 10% sample of term births ≥ 2,500 g (n = 4063). Pregnancy-induced hypertension cases, term small-for-gestational-age (SGA) cases, and term birth weight births were identified exclusively from the 10% random sample of births. Control groups for each of the outcomes were derived as noncase subsets from the 10% random sample of the entire population of live births.To efficiently select control groups and expand the range of birth outcomes, we first constructed a stratified 10% random sample of the entire population of live births by combining the 10% sample of all term live births ≥ 2500 g with a 10% random sample of the comprehensively identified preterm cases and term low birth weight cases (the case groups described above) (a) stillbirths (n = 106) compared with West Virginia live births  because stillbirth information was available only from West Virginia; b) pregnancy-induced hypertension cases (n = 224) compared with births without pregnancy-induced hypertension ; c) preterm birth cases < 37 weeks  and < 32 weeks (n = 491) corresponding to all preterm and very preterm births, respectively, compared with term births , with assignment based on clinical assessment of gestational age; d) term low birth weight cases (n = 918) compared with term births ≥ 2,500 g ; and e) term SGA cases  , indicating modest loss of information from lack of street level assignment. To make optimal use of the available data, we used the ZIP code average exposure and other information from the birth certificate  to impute a new exposure estimate for the pregnancies with ZIP code geocodes only . We used multiple imputation to generate 20 replications to obtain accurate information on the variability in the imputed values (n = 2), maternal education (n = 61), parity (n = 6), and tobacco use (n = 64) were also imputed. The primary analyses incorporate the exposure estimates for the street-level geocode (66%) and the imputed exposure estimate when only ZIP code geocodes could be assigned (34%). In sensitivity analyses we considered the impact of restricting to births with exposure estimates based on street-level geocodes only and no missing covariate data.We were able to geocode the maternal address listed on the birth certificate to the street level for 66% of births and to the ZIP code level for the remaining 34%, with little variation in these proportions by case or control status. We found a high correlation between the exposure estimate using street level geocode and ZIP code averages , education , parity , tobacco use , exposure year (splines with 4 degrees of freedom), and state of residence . In addition, we included gestational age  as a covariate in the analysis of birth weight among term births.For the binary outcomes, we used logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI) associated with PFOA exposure, using the log-transformed value to generate ORs for an interquartile shift from the 25th to 75th percentile, and the untransformed variable used to generate ORs per 100-ng/mL shift and for quintiles . Both crude and adjusted effect estimates were generated. We used multiple linear regression to estimate the association between PFOA and birth weight, using the same measures of estimated PFOA exposure described for the categorical outcomes. All statistical analyses were conducted using SAS version 9.2  and R version 2.12.1 .Births were nearly evenly divided by calendar period and by state . EstimatStillbirth was unrelated to PFOA exposure based on either continuous or categorical exposure measures . Althoughttp://dx.doi.org/10.1289/ehp.1104752)]}, but no monotonic gradient across quintiles. In the sensitivity analysis restricted to the 66% of births with street-level geocodes and complete covariate information  mother’s county and state of residence + mother’s date of birth + month and year of infant’s birth + infant’s sex; b) mother’s county and state of residence + mother’s age + mother’s first name, middle initial, last name + month and year of infant’s birth + infant sex; or c) mother’s county and state of residence + mother’s address + mother’s age + month and year of infant’s birth + infant sex. This process yielded 3,323 matched births. We extended the matching through the West Virginia Birth Score project, a program of the We sought to link births from 1990–2004 birth certificates in a 13-county region in West Virginia  and Ohio  to self-reported births in the C8 Health Project. This 13-county region encompasses the 5 counties included in study I. We considered a match to be accurate based on consistency between the birth certificate and C8 Health Project information for one of three combinations: We used the same environmental/pharmacokinetic models from study I to generate annual exposure estimates, except that the link to the C8 Health Project enabled us to incorporate lifetime residential history, thus reducing exposure misclassification , 2011b. As in study I, PFOA exposures were higher in the more recent time period, among older and more highly educated mothers, and among nonsmokers; however, in study II exposures were higher for Ohio births than West Virginia births, presumably reflecting the different geographic scope of the two studies .Pregnancy-induced hypertension showed essentially no association with estimated serum PFOA based on the uncalibrated estimates . With BaPreterm birth < 37 weeks was weakly related to PFOA levels based on continuous measures in the uncalibrated analyses, but with no gradient across quintiles . Bayesiahttp://dx.doi.org/10.1289/ehp.1104752)].Term low birth weight was largely unrelated to PFOA based on exposure measures without calibration, except for an isolated increased risk in the 4th quintile . With boIn study I, PFOA and Pregnancy Outcome Based on Birth Records, we found little indication of an association between PFOA and stillbirth, pregnancy-induced hypertension, preterm birth, or indicators of fetal growth. These analyses had the advantage of relative freedom from selection bias and large study size, but exposure was estimated based only on the residential address reported on the birth certificate rather than a lifetime residential history. Study II, PFOA and Pregnancy Outcome Based on Birth Records Linked to the C8 Health Project, yielded sporadic positive associations but little overall support for an association with pregnancy-induced hypertension or preterm birth< 37 weeks, modest support for an association with indicators of fetal growth restriction, and strong but imprecise indications of an association with preterm birth < 32 weeks. These analyses incorporated better estimates of exposure by using lifetime residential history, but a smaller sample size and the potential for selection bias from incomplete matching of birth certificates to the C8 Health Project.n = 626), the Spearman rank order correlation coefficient between the exposure estimate based on reported lifetime residential history versus just the maternal residence on the birth certificate was 0.64, reflecting a modest correlation and a clear loss of accuracy in study I.Study I and study II differ in several ways, including comprehensiveness and precision, but exposure assignment is probably most influential: Study II had residential history information for reconstructing exposure, and study I did not. Among the participants in both studies  PDFClick here for additional data file.


Ficus deltoidea Jack (Moraceae) has had a long history of use in traditional medicine among the Malays to alleviate and heal ailments such as sores, wounds, and rheumatism and as an after-birth tonic and an antidiabetic drug. Modern pharmacological studies demonstrated that this plant has a wide variety of beneficial attributes for human health. Despite its importance, a review of this species has not been published in the scientific literature to date. Here, we review and summarize the historic and current literature concerning the botany, traditional uses, phytochemistry, pharmacological effects, and toxicity of this wonder plant. This summary could be beneficial for future research aiming to exploit the therapeutic potential of this useful, medicinal species. For many years there has been a tremendous interest in biological products gained from megadiversity countries like Malaysia. These invaluable products are explored for the potential discovery of novel biomolecules that have possible future uses. Recently, natural plant products have been gaining popularity in the prevention and treatment of various diseases. Traditional medicines from plants have attracted major attention worldwide because of their potential pharmaceutical importance. Ficus deltoidea Jack, a plant of the family Moraceae. Ficus deltoidea not only has been used as a medicine for various ailments in the Malay Archipelago, but also has been distributed and formulated as capsules, tea, and tonic tea throughout Malaysia. This review will unify fragmented information regarding F. deltoidea in terms of its botany, traditional uses, phytochemistry, and pharmaceutical effects in order to facilitate better understanding and provide further support for the ethnopharmacological use of this important species.One of the most popular and well-known plants with a long history of use among the Malays is Ficus deltoidea Jack.Its botanical name is F. deltoidea var. angustifolia (Miq.) Corner, F. deltoidea forma angustissima Corner, F. deltoidea var. arenaria Corner, F. deltoidea var. bilobata Corner, F. deltoidea var. borneensis Corner, F. deltoidea forma subhirsuta Corner, F. deltoidea var. kunstleri (King) Corner, F. deltoidea var. lutescens (Desf.) Corner, F. deltoidea forma longipedunculata Corner, F. deltoidea forma subsessilis (Miq.) Corner, F. deltoidea var. peltata Corner, F. deltoidea var. recurvata Kochummen, and F. deltoidea var. trengganuensis Corner [The synonyms ares Corner . F. deltoidea var. oligoneura (Miq.) Corner [The synonym is) Corner .It is commonly known as mistletoe fig and also as Mas Cotek, Telinga Beruk, or Serapat Angin by Malays. Other vernacular names include Sempit-Sempit and Agoluran for people in Sabah, Sarawak, and the Kalimantan Islands, Tabat Barito in Indonesia, and Kangkalibang in Africa.Ficus deltoidea is an evergreen shrub that reaches a height of 2 meters, with whitish grey bark, leaves broadly spoon-shaped to obovate, with a leaf length between 4 cm and 8 cm, coloured bright green above, and rust-red to olive-brown beneath. The plant produces figs that are spherical to round, with a width of 1.0 to 1.5 cm and coloured yellow to orange-red  and mass spectrometers. Later on, an antibacterial compound known as lupeol (C30H50O) was also isolated from the leaves of F. deltoidea and exhibited toxicity against Staphylococcus aureus, Bacillus subtilis, and Escherichia coli [ F. deltoidea influenced by different carbon sources as well as plant growth regulators. A comprehensive study on flavonoid compounds of aqueous extract of F. deltoidea was conducted by Omar et al. [α-glucosidase inhibition [ F. deltoidea to date are presented in A wide range of chemical compounds have been isolated and characterized fromé et al. , 5. The é et al.  isolatedhia coli . Ong et hia coli  demonstrr et al.  using HPhibition . The metFicus deltoidea is traditionally used in Malaysia to control blood sugar levels. Adam et al. [ F. deltoidea in order to enhance basal and insulin-stimulated glucose uptake into the Chang liver cell line. The results show that F. deltoidea extracts and fractions, with the exception of petroleum ether, possess the potential to stimulate basal and insulin-stimulated glucose uptake into the liver cell line, with ethanolic extract having the highest insulin mimetic activity. Another study by Adam et al. [ F. deltoidea inhibit rat intestine α-glucosidase activity significantly, an enzyme that is accountable for carbohydrate digestion to condense the effect of carbohydrate in blood sugar. This was supported in an animal model in which all extracts reduced postprandial hyperglycemia after sucrose administration. Methanolic extract was found to be the most potent inhibitor of α-glucosidase [m et al.  evaluatem et al.  reportedcosidase . F. deltoidea showed visible α-glucosidase and α-amylase inhibitory effects to control postprandial hyperglycemia. A different study conducted by Adam et al. [ F. deltoidea on glucose levels in normal rats showed that all doses reduced fasting blood glucose, especially after 6 hours of administration. Adam et al. [ F. deltoidea for hyperglycemia effects at different prandial states. The study found that hot aqueous extracts of F. deltoidea stimulate insulin secretion and show a high magnitude of stimulation and the extract induced the usage of intracellular Ca2+ to initiate release of insulin, whilst increased basal and insulin-mediated glucose uptake into adipocytes cells was observed with ethanolic and methanolic extracts.Another study by Farsi et al.  reportedm et al.  to evalum et al.  also evaα-glucosidase inhibition assay. Both vitexin and isovitexin significantly reduced postprandial blood glucose level in mice, were nontoxic even at the highest dose of 2 g per kg, and exhibited in vivo  α-glucosidase activity  expression also decreased when F. deltoidea extract was applied, suggesting that F. deltoidea has strong potential for use as a depigmenting agent in cosmetics.oduction . Ficus d F. deltoidea extract also significantly inhibited UV-induced TNF-α, IL-1α, IL-6, and COX-2 expression [ F. deltoidea extract treatment. Furthermore, following UVB irradiation enhanced MMP-1 expression that would usually be observed decreased after treatment with the F. deltoidea extract in a dose-dependent manner. The study concluded that the F. deltoidea extract may have a positive effect against UVB-induced skin damage and that it is useful for antiphotoaging cosmetic products [Treatment withpression . Decreasproducts . F. deltoidea extract was revealed through a total phenolic content and ferric reducing antioxidant potential (FRAP) assay by Omar et al. [ F. deltoidea . Pretreatment with F. deltoidea extract demonstrated considerably less gastric mucosal lesions produced by ulcerogens compared to the negative control. Predictably, gastric protection was more effective with use of 500 mg kg−1   F. deltoidea extract compared to 250 mg kg−1. The negative control rats showed very severe gastric mucosal damage as well as edema and leucocyte permeation of the submucosal layer, suggesting that F. deltoidea extract protects against ulcers, demonstrated by the reduction in ulcer areas, inhibition of submucosal edema, and reduced leucocyte infiltration.The potential ofa et al. . Four gr F. deltoidea extract for healing of wounds in Sprague Dawley rats were evaluated by Abdulla et al. [ F. deltoidea extracts showed significantly accelerated wound healing in comparison with deionized water (negative control) and blank placebo treatments. The rats treated with F. deltoidea also showed decreased scar width, more fibroblast proliferation, and more collagen fibres accompanied by angiogenesis in the granulation tissue.The effects ofa et al. . The gro F. deltoidea leaf extract has antimicrobial activity towards Helicobacter pylori, the major agent in chronic gastritis and gastric ulcers. Methanol extracts of F. deltoidea showed highest activity against H. pylori with an inhibition zone diameter of 12.0 ± 0.6 mm followed by petroleum ether 10.0 ± 0.6 mm and chloroform extract 8.0 ± 0.1 mm. Another study found that ethanol and methanol extracts of F. deltoidea leaves inhibited growth of Bacillus subtilis [ F. deltoidea exhibited antibacterial activity against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa and antifungal activity towards Candida albicans.A study by Uyub et al.  found thsubtilis . This wasubtilis  who foun F. deltoidea were found to have anticancer activity against human ovarian carcinoma cell line A2780 using a cell-based assay and confirmed by microscopic observation [50 value of 224.39 ± 6.24 μg/mL and 143.03 ± 20.21 μg/mL in aqueous and ethanolic extracts, respectively. Both of the plant extracts have different effects on cell growth: the aqueous extract promoted cell detachment, while the ethanolic extract decreased cell proliferation. This might be due to different types of phytochemical property in those two extracts. The study also reported that apoptosis was caused by both extracts at 1000 μg/mL.Aqueous and ethanol extracts ofervation . The pla F. deltoidea leaves possessed antithrombotic activity and to observe the effect of the extracts on sperm quality and testosterone levels in diabetic rats [ F. deltoidea demonstrated significantly increased testosterone levels, sperm count, and motility and showed a reduction in the blood clotting levels and blood glucose level, as well as a reduction in sperm abnormalities.A study was conducted to assess whether the aqueous and ethanolic extracts oftic rats . These r F. deltoidea on LDH-C4 activity was also seen positive for maintaining healthy sperm. A further study on the effects of F. deltoidea methanolic extract on the reproductive systems of male rats was conducted by Norrizah et al. [Samsulrizal et al.  conducteh et al. . Surpris F. deltoidea [ F. deltoidea leaves do not contain toxic elements by evaluating toxicological elements  using atomic absorption spectroscopy technique, standardisation parameters , and Microbial Limit Test (MLT) for microbial contamination.Comprehensive attempts have been made on efficiency and safety studies oneltoidea –36. A steltoidea  confirme Salmonella typhimurium strains and showed the F. deltoidea extract did not have any potential to induce mutations in the presence or absence of S9 metabolic activation [50 of the extract was greater than 5000 mg/kg on Sprague Dawley rats treated with five different doses of the extract. In the subchronic study, there were no significant adverse effects on body weight, organ weight, food consumption, mortality, haematology, histopathology, and clinical chemistry, except an increase in the serum urea level [A genotoxicity study was performed using the Ames test with the TA98 and TA100tivation . Furtherea level . F. deltoidea indicated that this plant has received increasing interest in recent years. Ficus deltoidea has been reported to have beneficial pharmaceutical uses as an antidiabetic, anti-inflammatory, antinociceptive, antimelanogenic, antiphotoaging, antioxidant, antiulcerogenic, and antibacterial agent. Phytochemical and pharmaceutical studies have validated the traditional uses of F. deltoidea; however, there is a need to investigate the chemical or bioactive components that are responsible for providing the specific properties. The principle bioactive metabolites have to be examined for their bioactivities and their mechanism of action needs to be determined, in conjunction with analysing the pharmacokinetics and physiological pathways of specific compounds in F. deltoidea. These may help to strengthen our understanding of this highly therapeutic plant for commercial exploitation.The scientific research on


We found negative effects of f on birth date, calf body mass and twinning rate. The relationship between f and calf body mass and twinning rate were found to be separate but weaker after accounting for birth date. We found no support for an inbreeding effect on the age-specific lifetime reproductive success of females. The influence of f on birth date was related to climatic conditions during the spring prior to birth, indicating that calves with a low f were born earlier after a cold spring than calves with high f. In years with a warm spring, calf f did not affect birth date. The results suggest that severe inbreeding in moose has both indirect effects on fitness through delayed birth and lower juvenile body mass, as well as separate direct effects, as there still was a significant relationship between f and twinning rate after accounting for birth date and body mass as calf. Consequently, severe inbreeding as found in the study population may have consequences for population growth and extinction risk.Inbreeding can affect fitness-related traits at different life history stages and may interact with environmental variation to induce even larger effects. We used genetic parentage assignment based on 22 microsatellite loci to determine a 25 year long pedigree for a newly established island population of moose with 20–40 reproducing individuals annually. We used the pedigree to calculate individual inbreeding coefficients and examined for effects of individual inbreeding ( Small and isolated populations have an increased risk of extinction from genetic drift and inbreeding as opportunities for mating become restricted and the probability of mating between relatives increases Lande . The conInbreeding depression has been well documented through laboratory experiments and for zoo and livestock species Wright . EvidencMLH), but often report weak heterozygosity-fitness correlations (HFC's)  unlikely  population on the island Vega, off the coast of Northern Norway. Because the population was established by three founders in 1985, details on demography and life history have been established through annual radio-collaring  with individual multilocus heterozygosity (MLH), expecting a negative relationship. Finally, we assess to what extent effects of inbreeding are modified by environmental conditions, expecting that environmental stress should increase the effects of inbreeding.In this study, we show how fitness-related traits are affected by the level of individual inbreeding in the moose (2), is located approximately 13 km from the mainland. The island is relatively flat except for a mountainous part in the south-western quarter of the island that rises above the tree-line. The climate is oceanic with mild winters (mean temperature December–March: 0.5°C), cool summers (mean temperature June–August: 13°C), and a high level of precipitation . The vegetation consists of coastal heath  land with open to semiopen birch (Betula pubescens) forest, as well as areas of Scots pine (Pinus sylvestris), dense Sitka spruce (Picea sitchensis) plantations, marshes and farmland. Most farmlands are used for grass production and for grazing cattle  consists of several islands off the coast of northern Norway . The maiIn 1985, the island was colonized by three moose that were observed swimming to the island. By 1992, the population had increased to 24 adult individuals . Three hundred and eighteen were sampled as calves, 28 as yearlings, and 42 as adults. For 20 adults with unknown age at marking or culling, the year of birth was estimated from dental cement layers  were accepted as the true mother. Cows that were part of a parent pair assigning with strict confidence (>95%) were accepted as the true mother if no social mother was given or if the social mother involved mismatches in heritage that were confirmed by repeated PCR's (exclusion). Subsequently, parentage assignment was run again with the accepted mothers excluded as potential mothers in years they appeared with twins. To include as many individuals in the pedigree as possible, we made some additional assumptions described in supplementary S2. We also added results from six calves where social maternities previously had been verified and paternities assigned through fingerprinting , among which 170 corresponded with the social mother while 10 did not. By comparison, 119 individuals assigned with relaxed confidence, among which 95 had a social mother that corresponded in 75 of the cases. After exclusion of accepted twin mothers, ten additional relaxed assignments also corresponded with the social mother while only ten involved another mother. Combined (strict and relaxed), only 20 maternities did not match the social mother. For the fifteen assumed immigrants (including the three founders) and five other individuals sampled as adults, no parent pair or maternity assigned or matched in any year, and these were subsequently treated as immigrants. For more details on parentage assignment and the pedigree, see supplement (S2).f-value, was calculated using Pedigraph 2.4 (Garbe and Da MLH) was estimated as the proportion of heterozygous genotypes across loci for each individual. To assess for correlation in heterozygosity across loci (identity disequilibrium), we used the REMS software to estimate the parameter g2, and through 1000 resampling iterations, we tested whether it was significantly different from zero  and heterozygosity (MLH) affected the following individual fitness-related traits: birth date (day number in year), calf body mass, and cow twinning rate and age-specific lifetime reproductive success (asLRS). Because most individuals are culled and many die young, age was accounted for in asLRS. We followed a three-step approach, using Akaike's Information Criterion adjusted for small sample size , and the effects of birth date and calf body mass on twinning rate  and asLRS . Because of potential dependencies between observations due to individuals belonging to the same cohort, the same mother, or due to repeated observations per individual for analyses on twinning rate, we ran mixed models (see below for random structure for the different traits).We investigated whether inbreeding , if the calf was a twin or singleton, mother and father age, population size, and adult sex ratio were included as covariates. In step two, we also included spring temperature in the year of birth and summer temperature in the previous year as explanatory variables. Spring temperature can affect birth date by its effect on foraging conditions at the end of gestation period, whereas summer temperatures the previous year may affect birth date through a potential effect on mother body condition at the time of conception and during pregnancy.Birth dates were analyzed with a Gaussian error structure with year and maternal identity as random factors. The f and MLH of calves, mothers and fathers, mother and father age, mother parity, litter size, and the population size and adult sex ratio in the calving year. As climate variables, we used spring and summer temperatures in the year of calving.Calf body mass was measured as carcass mass for individuals shot during the autumn hunt or live body mass in winter. Because calves grow during autumn and may loose weight in winter, we adjusted body mass relative to the date of weighing . Year and cow identity was added as random factors. In addition, we included cow asLRS was unknown and we therefore first ran a generalized additive mixed model , which became almost linear after ln-transforming age, although the GAMM suggested a significant weak nonlinear relationship . We therefore used a generalized linear mixed model with poisson error structure and a log link function, and cow birth year as random factor. The ln-transformed cow age was included as covariate in addition to cow f and MLH, and population size at the cows' year of birth. As for the twinning rate, we included the interactions between f or MLH and cow age, and used spring and summer temperatures at the cows' year of birth as climate variables.The shape of the relationship between cow age and Significant deviations from Hardy–Weinberg equilibrium were only found in two cohorts for one locus (RT6 and BM804) among the 22 applied loci. After Bonferroni correction, significant linkage disequilibrium was only found between nine pairs of loci distributed among 6 years, as compared to the 231 pairs of loci tested each of the 25 years. The probability of null alleles was <0.05 in all loci. The combined nonexclusion probability of an unrelated candidate parent was 0.03 with no parents known and <0.001 with one parent known. Expected heterozygosity ranged from 0.23 to 0.82  and observed heterozygosity ranged from 0.22 to 0.86 . Allelic richness ranged from 2.7 to 7.7 .f) across years was 0.12  ranged from 0.14 to 0.86  and significantly different from zero (P < 0.001), indicating correlation of MLH across loci and identity disequilibrium. The individual MLH and f were correlated . For both f and MLH, there was a correlation between offspring and parents .Individual heterozygosity , which parameter estimate was highly uncertain . Moreover, the sum of AICc weights of candidate models including f was higher (0.601) compared with the sum of models including MLH (0.472), indicating that f was more important in explaining variation in birth date than MLH. Adding spring temperature in interaction with calf f increased the model fit  than models including MLH (sum of AICc-w of models including MLH: 0.349). Adding climate variables did not increase the fit of the highest ranked nonclimate model  and mother age . Calves from primiparous cows had lower body mass than calves from multiparous cows . When adding birth date to the model, the effects of calf f and mother MLH on calf body mass decreased and were associated with higher uncertainties , indicating that part of the effects of calf f and mother MLH on calf body mass is affected by birth date. Calf body mass was negatively related to birth date .Calf body mass was best explained by calf r parity A, as welf-value of the cow, whether she was primiparous or multiparous, and population size in the year of calving. Alternative models had little support (f (0.876) was almost twice as high compared with the sum from models including MLH (0.447). Adding climate variables from the cows' year of birth did not improve the fit .The twinning rate was best explained by the  support A. Moreov the fit B. AccordasLRS included only cow age (f produced a model of slightly lower support (ΔAICc = 0.28), and including cow MLH involved even less support (ΔAICc = 1.90). The sum of AICc-w for candidate models including f (0.519) was again higher than for candidate models including MLH (0.313), but neither sum was particularly high. As we focus on inbreeding effects, we used the second best model to explore the effects of climate, but allowed model selection to exclude f from the candidate models. Climatic conditions in the cows' year of birth did not improve the model . Consequently, there was no support for inbreeding effects on the asLRS.The highest ranked model explaining the variation in  cow age A. InclusAR mean = 3.7, SD = 1.1) and heterozygosity  than recorded in the mainland Norwegian population . This suggests strong genetic drift, as was expected from the few founders and subsequently low population size. However, albeit a low genetic variation, genetic parentage assignment was significant in most individuals. Interestingly, assignments with strict confidence corresponded very well with observed social maternities (95%). Also assignments with relaxed confidence corresponded with social maternities (83%) and after exclusion of accepted twin mothers, assignments with relaxed confidence corresponded even better with social maternities (92%). This high agreement between genetic and socially determined maternities provides credibility to previous ecological investigations at Vega  was high. The level of inbreeding was reduced following immigration but shortly after increased again  calf body mass was negatively related to calf f and increased with mother MLH, and (3) twinning rates were lower for cows with higher f-values. Inbreeding may operate on different life history stages  a lThe later date of birth for inbred calves may have two explanations: (1) that conception occurs later in the rut for inbred than for more outbred calves and (2) that inbreeding involves a longer gestation period. Variation in conception date can occur as a result of varying cow condition at the onset of rut . Hence, inbreeding effects on calves may also be affected by maternal effects, for example by the level of resources mothers allocate to the calf during gestation or lactation.The lower body mass in autumn and winter of inbred calves may be explained by lower birth weight and/or lower weight gain after birth. Previous studies have found calf body mass to be related to birth date (Sæther et al. The lower twinning rate of inbred cows may be because inbreeding affects the body condition of cows, which is known to affect reproductive performance in moose (Sæther and Haagenrud n = 50, Zachos et al. Oreamnos americanus, Ortego et al. Capra ibex, Biebach and Keller Because of population fragmentation and decline Parmesan , the pot


This study was performed between 2007-2012 and encompasses 94 patients. The patients were divided in two groups. The first group included the patients who have benefited from surgical treatment (42 cases) and the second one included patients who benefited from conservative treatment. Out of the total number of cases, 63 cases showed an intact simple bone cyst that was most of the time an accidental discovery. 31 patients presented with fracture sustained on a simple bone cyst. There were 63 boys and 31 girls. Their mean age was 9.9 +/- 2.34 years. Single injection was performed for 49 patients; the rest had double or triple injections. The mean follow-up was 34.5 +/- 6.6 months. The procedure succeeded in obtaining healing in 77 cysts (82%). Cyst index of more than five and cortical index of less than 1 mm were significantly prone to pathological fractures and had significant poor results after treatment. Our results suggested that an autogenous bone marrow injection is a safe and effective treatment method for simple bone cysts, when compared with the surgical management, but sometimes-repeated injections are necessary. Cyst index and cortical width are good indicators for treatment outcome. Although the pathogenesis is still unknown [11], the lesion appears to be reactive or developmental rather than to represent a true neoplasm [1]. SBC consists of a solitary cavity lined by a membrane of variable thickness and filled with a clear yellow fluid [2]. It represents approximately 3% of all primary bone lesions [4].The simple bone cyst is the most common benign lytic bone lesion in childhood, mainly affecting the proximal femur and proximal humerus. The simple bone cyst (SBC) also called unicameral bone cyst is a tumor-like lesion of unknown cause, attributed to a local disturbance of the bone growth [15]. In this case, one examination of the fourth recurrence by polymerase chain reaction revealed a TP53 mutation [16]. Until now, only two SBC’s have been examined cytogenetically, revealing complex clonal rearrangements involving chromosomes 4,6.8,12,16 and 21 in one case and a translocation  in the second case [13]. About 65% of these cysts occur in teenagers and an additional 20% in the first decade of life. The vast majority of SBC are located in the proximal diaphysis of the humerus and femur, especially when they occur in patients younger than 17 years old [12]. The symptoms include pain, swelling, or stiffness at the nearest joint. (3) A pathologic fracture is often the first sign of the lesion.  In fact, this is the most common complication of the SBC and occurs in about 66% of the cases. In older patients the incidence of involvement of atypical sites, such as calcaneus, talus, and ilium rises significantly [13]. In these sites, the lesion is usually asymptomatic and is discovered by accident. The SBC is more common in males 3:1 and is usually detected during the first 2 decades of life [Fig. 1). Epiphyseal extension is unusual [8]. Radiographically, the appearance of an SBC is that of a centrally located, well-circumscribed, radiolucent lesion with sclerotic margins. The lesion is located within the diaphysis or the metaphysis of a long bone, abutting or being remote from the cartilaginous growth plate . The effectiveness of this method was studied according to different factors that affect the outcome including the aggressiveness of the cyst.Fig. 2). From 2007 to 2012, 94 consecutive patients with diagnosis of SBC were treated in the authors’ institute by: aspiration and percutaneous ABMI or steroid injection (methylprednisolone), and surgical treatment. Confirmation of the diagnosis was based on characteristic radiographic appearance and histological study of the specimen taken by aspiration. There were 63 boys and 31 girls. The mean age at the outset of treatment was 9.9 +/- 2.34 years (range 6-17). The cyst localizations were humerus 50 cases, radius 5 cases, V-th metacarpal 1, femur 25, peroneus 8, tibia 4, calcaneus 1 .55 cysts were uniloculated and 39 were multiloculated. Cyst size is defined as the ratio of the length of the cyst to the width of the adjacent physis, which allows a direct comparison of the sizes without requiring correction factors for different ages. The mean size of all cysts in this study was 1.857 +/- 0.473 (range 0.9-3.1). The fracture risk was evaluated by measuring the cyst index of Kaelin and Mc Ewan and the cortical thickness. The cyst index is the cyst area divided by the squared diaphyseal diameter. One or more trapezoids are drawn around the cyst area. Mechanically, a cyst is considered not prone to fracture when the index is lower than 3 and the cortical width is lower than 2 mm. The patients were divided by Cyst Index (CI) as it follows: upper limb with a CI >4 – 40 patients, upper limb with a CI <4 – 22 patients, lower limb with a CI <2 – 7 patients, lower limb with a CI 2-3,5 – 11 patients, lower limb with a CI > 3,5 – 20 patients .Surgical treatment consisted in elastic reinforcement 5 cases, dyaphisectomia + bone graft 4 cases, curettage and bone grafting 11 cases, curettage of cystic cavity and osseous substitute 8 cases, curettage of the cystic cavity and structuralized bone graft plus stabilization 24 cases . In the quantification of the results, we considered the occurrence of the recidivated cysts, time span until the total healing and the number of injections needed in the case of steroid injection and ABMI. In the case of surgical management, we encountered recidivated cysts in 14 patients. Upper limb accounted for 12 recidivated cysts and the lower limb for only 2 . Time span from the surgical intervention to total healing of the cyst varied between 6 months and 2 years with a peek incidence between 12 and 18 months (30 patients)  occurred in the cases with latent cysts, and for the cases which needed prolonged periods of time for healing several surgical procedures were needed.Fig. 7).  From the conservative point of view, in the case of steroid injection, the quantification of the results was also based on the number of injections to achieve healing. According to the number of injections until healing, patients were distributed as it follows 1 injection -0 cases, 2 injections- 2 cases, 3 injections 10 cases, 4 injections – 14 cases. Five patients had no response to the treatment whatsoever, and they were managed surgically (We used ABMI to 12 of our patients. The first and most important conclusion was that most of the patients (9) had a good response since their first injection. According to case partition and taking into account the time span from the debut of the conservative treatment and the mechanical healing of the cyst , we observed that most of the patients were grouped in the 6 months-1 year interval. The cases that needed more time for the healing were most of them part of the cast immobilization group. Fig. 8b).After the surgical management, a large proportion of the patients sustained a recidivated cyst. These recidivated cysts were encountered in those cases that were treated with curettage and osseous graft or osseous substitute .After a brief period of time that mimed healing, we encountered the reappearance of the cyst, most of the time in the inferior pole of the old cyst. In the upper limb most of the recidivated cyst appeared in the humerus. The only surgical management that did not lead to a recidivated cyst was elastic reinforcement and osseous reconstruction with diaphysectomy. The only impediment related to simple elastic reinforcement was the period of time needed for the healing of the lesion, which proved to be very long. In the case of osseous reconstruction with diaphysectomy, this procedure is prone to a far greater morbidity rate. We recommend this kind of treatments only in the cases of conservative management failure and in cases of displaced pathological fracture. The conservative treatment consisted in simple cast immobilization of the pathological fracture localized in the upper limb and without fragment displacement, ABMI or steroid injections. The last two methods of treatment were employed only in those cases that sustained a cyst without a pathological fracture or after the healing of a previous pathological fracture, which did not lead to cyst healing. Those cases that sustained a pathological fracture localized at the level of the upper limb were successfully treated by conservative means, the result being the healing of the fracture and subsequently of the cyst. In the case of the steroid injection, we encountered 5 cases that had no response, in comparison with ABMI, in which case we encountered a 100% rate of lesion healing, even from the first injection (- A recidivated cyst frequently follows surgical management by the method of curettage and grafting. - Diaphysectomy and osseous graft leads to a hundred percent healing, but it is followed by great rates of morbidity and it is unnecessarily laborious. - The logical treatment for SBC, that sustained a pathological fracture, as well as in the case of an ordinary fracture.  - Steroid injection may be accompanied by failure, and only exceptionally, healing occurs before the third injection. - ABMI is a simple cost free method, effective in both active cyst and inactive cyst, and certain signs of healing follow it in most of the cases since the first injection.


For ten years, the incidence of preterm birth does not decrease in developed countries despite the promotion of public health programs. Many risk factors have been identified including ethnicity, age, tobacco, and infection. However, almost 50% of preterm birth causes remain unknown. The periodontal diseases are highly prevalent inflammatory and infectious diseases of tooth supporting tissues leading to an oral disability. They influence negatively general health worsening cardiovascular diseases and diabetes. Periodontal diseases have been also suspected to increase the rate of preterm birth, but data remain contradictory. The objective of this review is to present the principal results of epidemiological, biological, and interventional studies on the link between periodontal diseases and preterm birth. The conclusions of this work underline the importance for the physician/obstetrician to identify women at risk for preterm birth and to address these patients to dentist for periodontal examination and treatment in order to limit adverse pregnancy outcomes. Preterm birth is defined as any delivery that occurs after 23 gestational weeks and less than 37 weeks , 2. ThisThe role of many risk factors have been shown by results of epidemiological studies such as increasing age of women giving birth, ethnical origin, tobacco, socioeconomic disparities, maternal body-mass index, or multiple pregnancies , 10–12. The periodontal diseases are inflammatory diseases of gum and tooth supporting tissues caused by the oral bacterial biofilm containing almost 300 different species –21. DiffGingivitis is a common pathology that affects everyone in his life . It corresponds to an inflammation of superficial soft tissues around teeth initiated by supragingival biofilms accumulation. The principal clinical signs are bleeding during tooth brushing or mastication, gum swelling, and gingival pains. Gingivitis is due to an absence or inappropriate oral hygiene habits and is worsened by local factor increasing dental plaque retention including supra-gingival calculus, retentive crown or dental misalignment, and absence or irregular dental cares. Consequently, oral hygiene education, scaling, and monitoring are very efficient to treat and prevent gingivitis . Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans (Aa), and Treponema denticola [The prevalence of periodontitis is about 60% with a pick of incidence at 60 years . Periodoenticola   , associaPorphyromonas gingivalis, Prevotella intermedia [Campylobacter rectus [Interestingly, pregnancy influenced also periodontal status. Pregnant women are more susceptible to inflammation and display an increase of gingival bleeding on probing. Pregnant women present generally periodontal pocket due to gingival swelling rather than periodontal tissue breakdown . These ptermedia , or Campr rectus .P < 0.02), Offenbacher et al. [P = 0.013), López et al. [P < 0.0004 and RR = 3.5), Siqueira et al. [P < 0.001), Rajapakse et al. [P < 0.01), Agueda et al. [P < 0.001), and also in case-control studies by Gomes-Filho et al. [P < 0.0001). However, some other investigations did not find a significant association, such as cohort studies by Moore et al. [During the last decade, numerous epidemiological studies have been conducted on the association between preterm birth and periodontitis . More orr et al.  , e et al.   and may confound the association between periodontitis and preterm birth , 62, 63.Considering epidemiological evidence, biological theories have been proposed to link preterm birth and periodontal diseases . Mainly,bacterial spreading, inflammatory products dissemination,  role of feto-maternal immune response against oral pathogens. 2 in the most severe cases) [Bergeyella, Eikenella [Fusobacterium nucleatum, or Porphyromonas gingivalis [The current paradigm indicates that majority of intrauterine infection originates in the lower genital tract . Despitee cases) . Many anikenella , Fusobacngivalis –74. Insingivalis . In vivo studies show that the invasiveness of uterine tissues largely depends on the type of bacteria. In a sheep model of intra-amniotic injection of lipopolysaccharide from different bacterial species, it appears that periodontopathic lipopolysaccharides induce a high rate of fetal lethality [Porphyromonas gingivalis is dose and strain dependent [Porphyromonas gingivalis and Fusobacterium nucleatum, have been studied. For example, Porphyromonas gingivalis could infect syncytiotrophoblasts, chorionic trophoblasts, decidual cells, and amniotic epithelial cells [ethality . Furtherependent . Potential cells  and promal cells . Fusobacterium nucleatum from the mother's mouth [Finally, a case-report study has been published in 2010 concerning a stillbirth caused by 's mouth . This stα, IL-6 or IL-1β [β, or Il-6 have been associated with their elevated levels in amniotic fluid [Acute inflammation is responsible for a substantial fraction of preterm birth . In 1998or IL-1β , 82. Anaor IL-1β . We hypoic fluid , 84. Theic fluid .α, IL-1 or IL-6 are associated to a hyperinflammatory response. The consecutive overexpression of these cytokines increases the risk of preterm birth [The immune and genetic characteristics of fetus and pregnant women are one of the potential mechanisms linking periodontal diseases to preterm birth. Numerous studies have analyzed fetal and maternal antibodies directed against oral pathogens during pregnancy. In the study of Boggess et al., 35.2% of samples are Ig-M positive for at least one oral pathogen, and 26.6% are positive for more than one. The presence of Ig-M is associated to an increased risk of preterm birth . This imrm birth –89. The mechanisms linking periodontal diseases and preterm birth are not well defined. Further investigations should be performed to evaluate the impact of each theory. Nevertheless, we hypothesized that the influence of periodontal diseases on preterm birth is the result of an inflammation of the fetomaternal unit that is amplified in women presenting particular phenotype.Considering periodontal diseases as a risk factor for preterm birth, interventional studies have been performed to evaluate impact of periodontal treatment on pregnancy outcomes. Case-control studies including a relative large number of pregnant women (>400) show some apparent contradictory results and different conclusions , 90–94. Despite apparent conflicting data, the majority of studies report that periodontal treatment is safe for pregnant women and improve periodontal status , 92, 94.Periodontal diseases appear to be a potential risk factor for preterm birth. As well as other modifiable risk factors, these diseases must be taken in charge. Cooperation between obstetricians or general practitioners and periodontists should be developed. The promotion of the early detection and treatments of periodontal disease in young women before and during pregnancy will be beneficial especially for women at risk.