While birth weight and weight gain have been associated with hypertension (HT), the association of linear growth, independently of weight gains, has been less well studied. We assessed the independent association of body mass index (BMI) and length at birth and changes in BMI and height during the first two decades of life with adult blood pressure (BP). A birth cohort (n = 1141) was assembled in 1978–79, and followed up at school-age and adulthood. We used conditional length and BMI measures. BMI at birth was inversely associated with HT; c-BMI from school age to adulthood and c-height from birth to school age were positively associated with hypertension. Early adiposity accretion from birth to 9 years and late linear growth from 9 to 24 years were not associated with increased HT. Regarding BP, systolic and diastolic BP presented similar partterns: the lower the BMI at birth the higher the adult BP; the higher the BMI gains in the first 2 decades of life the higher the adult BP; linear accretion only in the first decade of life was associated with adult BP. Linear growth in the first decade of life and fat accretion in the second decade are associated with adults HT. Many studies have shown an inverse association of birth weight with adult blood pressure3. The Consortium of Health-Orientated Research in Transitioning Societies group found a small inverse association of birth weight, and a stronger positive association of postnatal weight gain, with systolic blood pressure, with no association of either birth weight or later weight gain with diastolic blood pressure4.High blood pressure is widely prevalent in low and middle-income countries5, and associations between length/height and body mass index with blood pressure have been less comprehensively examined. While height is correlated with blood pressure in cross-sectional models6, height gain has not been extensively studied; in one study height gain was positively associated with systolic but not with diastolic blood pressure at 10 years of age7, but studies have not extended into adulthood. Birth weight has most consistently been associated with systolic blood pressure in adulthood but associations with diastolic blood pressure are still inconclusive3. Few studies have been conducted in low and middle-income settings where the burden of hypertension is emerging rapidly, and even fewer have taken a life-course perspective8.Birth weight is a limited indicator of fetal developmentThe relationship between linear growth and later blood pressure has been studied less frequently than the relationship between weight change in childhood and later blood pressure, and has not been studied previously using growth from birth to adulthood. Thus, the objective of the present study was to assess the independent associations of body mass index (BMI) and length at birth and changes in BMI and height from birth through childhood and from childhood through adulthood with adult HT and systolic and diastolic blood pressure, in a middle-income country setting.10. In 2002/04, when individuals were aged 23–35 years, 5665 of the 6484 participants who were not known to have died were traced. A systematic 1 in 3 sample was performed  and 2063 cohort members were invited and reinterviewed . In 1987–89, a school-age follow-up was conducted at child age 9–11 years. 2861 members of the cohort were identified, invited to participate, agreed and interviewedData from both the school and adult waves were available for 1141 individuals. This sample size has approximately 80% power to detect a risk ratio of 2.0, assuming the event has a 10% prevalence in the control group, with a 5% probability of type I error.12; maternal age at delivery in years ; maternal schooling in years ; number of cigarettes smoked per day during pregnancy ; maternal hypertension during pregnancy; type of delivery ; gestational age in completed weeks based on the date of the last menstrual period. When unknown or implausible, missing gestational age was imputed in a regression model13, using birth weight, parity, family income and newborn gender. The newborn was considered preterm if the gestational age was <37 complete weeks. Maternal ethnicity was categorized as black and non-black based on self-reported skin colour.Maternal characteristics were collected by interview with the mother soon after birth. We extracted the following variables: ethnicity, occupation of the family head, based on the International Classification of Occupation14.Trained personnel measured newborn weight and length immediately after delivery. The babies were weighed naked in weekly-calibrated scales with 10 g precision. Two staff measured length with the baby laid in supine position on a neonatometer15.At the school age examination, height and weight were measured according to standard techniques16 and individuals were classified as sedentary, insufficiently active and active. A food frequency questionnaire (FFQ) validated for the Brazilian population17 and applied by a nutritionist, ascertained information about intake over the last 12 months of 75 food items. The nutritional value of the diets was analyzed with the software Dietsys 4.0 , and Brazilian foods and food preparations complementary to the Dietsys program were added when complete data about them were available from Brazilian tables18. Participants’ daily alcohol consumption was considered as none, low (≤31 g) and high (>31 g). The sodium intake considered only the existing amount of sodium in the consumed foods and was categorized as: <2000, 2000–2500, and >2500 mg/d. The number of cigarettes smoked per day was categorized as 0, 1–10, or >10.As adults, the participants responded to a general questionnaire. Current occupation of the family head was classified in four categories: non-manual, skilled manual, semi-skilled manual, and unskilled manual. We administered the short version of the International Physical Activity Questionnaire (IPAQ)19 using a 740 Omron digital sphygmomanometer  with a single-size cuff that was adjusted to the arm circumference. One person made all measurements at 15-min intervals, with the participant resting in sitting position with the left arm at the height of the heart. The mean of the last two measurements was use in analysis. Individuals with a systolic blood pressure above 140 and/or a diastolic blood pressure above 90 were considered as hypertensive as were those individuals who were taking medications for hypertension.Blood pressure was measured in triplicate15.Weight was measured with an adult electronic scale  with 100 g precision. Height was measured to the nearest centimeter using a stadiometer, according to standard techniquesEthical approval was given by all maternities and by the Research Ethics Committee of the University Hospital, Faculty of Medicine of Ribeirão Preto, University of São Paulo (protocol no. 7606/99). All participants provided their written informed consent to participate in this study. These consents were approved by the ethics committee and one copy was given to the participant and one copy was kept with the research team.Mean and standard deviation were used to describe the Body Mass Index (BMI) and height according to sex and age. Systolic and diastolic blood pressure were described according to sex. Groups were compared using the t test. All variables were tested for normality.BMI and height were standardized for age and sex using ANTHRO® and ANTHROPLUS®, which use the World Health Organization reference data. Since ANTHROPLUS® only goes to age 19 years, we considered the value at this age as the final adult height.20. These are calculated as the residuals from linear regressions of BMI and height at a given age and gender on all earlier measures of BMI and height. A positive residual indicates that a child grew more rapidly during the interval than would have been predicted based on its initial values and prior growth.In order to eliminate the problem of collinearity among the three repeated measures of BMI or height, we computed conditional growth measures21. To deal with missing data we chose to perform inverse probability weighting, weighting for all variables that were linked to loss of follow up from birth to adulthood22.Frequencies were used to describe data according to the presence of hypertension or not in adulthood. Groups were compared through chi-square tests. We used Poisson regression to estimate incidence rate ratio (IRR) for HT and linear regression for systolic and diastolic BP23 . Adult risk factors for HT  did not fulfill the criteria do be considered confounders, because they are not antecedents of the exposures. This approach to deal with confounding covariates is increasingly being used26.To avoid overadjustment covariates were selected with the aid of a directed acyclic graph (DAG)Since the final number of covariables was large, we double checked the results by bootstrapping the adjusted models to ensure results were robust  in specific life stages with HT are shown in Table Table We found that lower BMI at birth was associated with higher adult HT. Higher than expected height gain in the first decade of life was associated with adult HT but higher than expected gain in the second decade of life was not. On the other hand, higher than expected BMI gain in the second decade of life was associated with HT but higher than expected BMI gain during the first decade of life was not. Regarding BP, systolic and diastolic BP presented similar partterns: BMI at birth was associated inversely and BMI gains in the first 2 decades of life positively; linear accretion only in the first decade of life was associated with BP.Our findings suggest that linear growth in early childhood, and increases in adiposity later in children, are important for risk of HT. The relationship between linear growth and later blood pressure has been studied less frequently than has the relationship between weight change in childhood and later blood pressure.et al.28 showed the importance of postnatal weight gain on blood pressure in mid childhood. Adair et al.4 demonstrated the importance of separating the effect of weight growth and linear growth on adult outcomes: on one hand, rapid height gain in the first years of life was associated with increased schooling and final height. Conversely, greater than expected weight gain in later childhood was linked to obesity, increases in systolic blood pressure and glucose impairment. However, Adair et al. do not have an age period that dichotomizes at the immediate pre-pubertal period.Faster growth has been related to a range of positive and adverse outcomes. Huang 29. Should we favor a rapid growth of a small for gestational age babies? Which growth parameter is best?In the context of blood pressure, taller adults have higher BP, but reduced risk for CVD3. As was also seen in the ALSPAC study30 length at birth was not related to adult blood pressure. However, we found stronger associations with hypertension for height gain in the first decade of life and weight gain in the second decade of life than in this study. These associations are stronger and positive compared with the inverse association of BMI at birth with hypertension. This could suggest that postnatal growth is more strongly associated with hypertension than is prenatal growth7.Our study helps to clarify some of these issues. Inverse associations of BMI at birth with hypertension are evident in young adulthood. This is in line with amounting evidence31. Moreover, there is evidence that growth in early life (first 48 months) has less influence in BP than growth from 48 months to adulthood32. Our results are also consistent with these strengthening associations of weight gain from birth to young adulthood with adult hypertension31. As others had already seen33, higher than expected BMI gain seems to be deleterious to adult blood pressure and this association seems to amplify across infancy and adolescence until early adulthood. We found that higher than expected BMI gain in the second decade of life was associated with higher blood pressure whereas BMI gain in the first decade of life was not. In addition, with simultaneous adjustment for weight and length/height gain the associations of weight gain on systolic and diastolic blood pressure were of similar magnitude. In ALSPAC, however, associations of BMI gain on DBP were weaker than those with SBP7.It has been pointed out that increases in relative body size are more predictive of adult blood pressure after age 11 years than in earlier childhood34 differences in adult height are already evident at the earlier time points. Our results are consistent with decreasing or even disappearing associations of height gain on adult hypertension because height gain was only moderately associated with SBP and not with DBP or hypertension in the second decade of life. In addition, association between height gain and SBP reduced from the first to the second decade of life. Thus, hypertension due to accelerated gains in height in early life seems not to persist through adult life. This decreasing or even vanishing association of height gain on adult hypertension seems to represent a physiological rather than a pathological effect. It might be explained by a mismatch between linear and renal/arteriolar growth and development35. It seems that in infancy and post-infancy, early linear growth spurts are not accompanied by similar developments in renal and arteriolar function, thus resulting in higher blood pressure. Our results suggest that this adaptative mechanism that results in higher blood pressure in early life due to the linear growth spurt are transient and do not track to adult life. In contrast, effects of BMI gain seem to persist and increase from birth to adulthood.Since height is related to BP, why then is height change in the period from childhood to adulthood not associated with adult BP? As has been demonstrated elsewhere4. However, Menezes reported that early length/height gains in the first four years of life are not associated with higher systolic blood pressure36.In agreement with our data, results from a pooled analysis of birth cohort studies from low and middle income countries also reported that height gains at age 2 years and mid-childhood but not in adulthood were associated with SBP7.It is important to note that in our study the association between height gain and diastolic blood pressure was only evident from birth to school age and was weaker than the corresponding association with systolic blood pressure. This is in contrast to ALSPAC data, in which diastolic BP at 10 years was not influenced by height growthThe present study has some strengths worth underlying: it is a population-based prospective birth cohort from a middle-income setting. The conditional modeling of height and BMI changes provides information on the relative contribution of BMI gain and linear growth in predicting adult blood pressure.34.A limitation of this study is measurement error. Newborn length is not always precisely measured. We minimized the potential for error by standardizing data collection. Blood pressure assessed at one point in time may be elevated because of white coat syndrome. This would affect the whole sample, resulting in non-differential misclassification. Another limitation is that losses to follow-up may have generated a sample with better health and social conditions than the original subjects at birth. If we had had access to these less healthy and wealthy subjects our effect size would possibly be stronger. However, we performed inverse probability weighting to minimize this bias. An important limitation is that no data are available on growth from birth to 2 years37.The independent association of growth patterns with adult hypertension, even after controlling for adult risk factors confirms that CVD prevention actions should not be restricted to adulthood. This evidence has been acknowledged by the United Nations heads of States and governmentsIn conclusion, postnatal growth seems to have more influence on hypertension than prenatal growth. Higher BP due to accelerated gains in height in early life seems to be an evidence for the first decade of life, but it does not track into the second one. Higher than expected fat accretion seems to be deleterious to adult blood pressure and its effect seems to be bigger in the second than in the first decade of life. Strategies for preventing fat accretion in the first and especially in the second decade of life are probably more important than strategies focusing on early mother and child nutrition to prevent hypertension in adulthood.Supporting Information


Ectopia cordis is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. It can be associated with other congenital abnormalities. Overall, the prognosis for infants with ectopia cordis is very poor but depends greatly on the type and severity of ectopia cordis and intracardiac and associated malformations. We present one case of a fetus with prenatally diagnosed thoracic ectopia cordis with intracardiac defects and omphalocele, all the abnormalities seen in pentalogy of Cantrell except a diaphragmatic defect. Considering poor prognosis for fetus, conservative management of prenatal care has been chosen. At the 42nd gestational week, during the active stage of labor, due to fetal distress, cesarean section was performed at a tertiary level hospital. The condition of the infant was impairing rapidly and the newborn succumbed within 24 hours. We discuss the perinatal care concerning this rare anomaly.  Ectopia cordis is defined as an anomaly in which the fetal heart partially or completely lies outside the thoracic cavity. It is a rare congenital abnormality with an incidence of 5.5 to 7.9 per 1 million live births and includes 0.1% of congenital heart diseases . The ectA 32-year-old woman, gravida 5 para 2, had no regular prenatal care before 24 weeks of gestation. An anterior thoracic defect with an extrathoracic two-chamber heart was recognized at 24 gestational weeks of uneventful pregnancy during the first ultrasonographic evaluation. There was no family history of congenital anomalies, genetic abnormalities, or history related to ectopia cordis. During pregnancy, the mother was smoking 15 cigarettes per day. An unfavorable prognosis to the fetus was predicted and conservative management of prenatal care had been chosen.http://dx.doi.org/10.1155/2016/5097059). At birth, the infant had hypotonia, weak cry, and generalized facial cyanosis. The physical examination revealed split sternum with complete thoracic ectopia cordis, the defect followed by anterior abdominal wall defect, supraumbilical omphalocele. Ectopic heart with partial absence of the pericardium was beating outside the thoracic cavity, at a rate of 130/min with remittent bradycardia. After birth, the infant's heart was covered with warm saline-soaked sterile dressing. The newborn girl was transferred to the specialized cardiac surgery centre, children's intensive care unit. She died within 24 hours. The parents declined postmortem newborn's autopsy.The woman was admitted to the tertiary level obstetrics and gynecology clinic during active stage of labor, at gestational age of 42 weeks. Diagnosis of congenital heart anomaly was heart ectopia, and septal ventricular defect was confirmed by ultrasound. Multiple anomalies were observed: wide anterior thoracic defect with extrathoracic four-chamber heart, rounded apex of the heart, high ventricular septal defect, the major blood vessels transposition, narrow pulmonary artery, and pericardium covering only ventricles Figures  and 2. DEctopia cordis (EC) is a rare and impressive congenital malformation, which was observed thousands of years ago. The term “ectopia cordis” has been used to describe all anomalies in which the heart was not located within the thorax . The etiUltrasound made as early as within the first trimester or by the start of the second trimester allows enough time to define the associated abnormalities in nearly 90% of the reported cases . EctopiaOverall the prognosis of ectopia is very poor, but depends greatly on the type and severity of EC, intracardiac and associated malformations, gestational week, birth weight, mode of delivery, or even by the available medical resources –17. CervPerinatal care when parents chose sustaining the pregnancy or termination is impossible because gestational age greater than 22 weeks has been rarely discussed in the literature. To offer the best care and therapy, a multidisciplinary medical team consisting of a perinatologist, a neonatologist, a radiologist, a pediatric surgeon, a cardiologist, a pediatric cardiac surgeon, a plastic surgeon, and palliative nurses should counsel parents preferably prenatally. Therefore, it is necessary to diagnose the severity of pathology and estimate the prognosis to fetus as precisely as possible to inform the family with frankness. Provided with accurate medical information about the delivery mode and possible infant care, the parents should decide autonomously. Decisions regarding fetal monitoring and mode of delivery are difficult. Parents choosing vaginal delivery should be informed about the possibility of fetus demise during labor due to prolonged cardiac compression, damage of herniated viscera, or rupture of an atrial diverticula or omphalocele sac . They alIn conclusion, early prenatal detection and precise diagnosis of ectopia cordis are essential for multidisciplinary team to provide optimal parental counselling for fetus/infant prognosis, aiding in developing a delivery plan and, when possible, postnatal management strategy.The newborn female at birth, presented with wide thoracic defect, four chambers heart with partialy absent pericardium and round-shaped apex was beating outside the thoracic cavity. This defect was followed by anterior abdominal wall defect, supraumbilical omphalocele.


Existing data on associations between maternal and early childhood exposures and juvenile idiopathic arthritis (JIA) risk is scant and inconsistent with previous studies showing potential role for prematurity, number of siblings and infections. We explored JIA and International League of Associations for Rheumatology (ILAR) JIA categories in relation to selected infant , and maternal  characteristics that may be markers for exposures related to two pathways  potentially associated with autoimmune disorder occurrence.A case–control analysis with 1,234 JIA cases and 5,993 birth year-matched controls was conducted. Exposure information was obtained from WA state birth certificates. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations with maternal and early life exposures for JIA and JIA categories.Greater maternal parity was associated with a decreased OR for JIA . Prior fetal loss (except for oligoarticular JIA) was associated with an increased OR for JIA. Prematurity was associated with increased risk of enthesitis related arthritis  and rheumatoid factor positive polyarticular JIA .We observed associations of selected maternal factors with JIA, some of which varied across JIA categories. The findings of decreased ORs for JIA in relation to greater maternal parity may be consistent with the hygiene and microchimerism hypotheses. Future studies with biomarkers relevant to these hypotheses will help elucidate any associations. Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of seven categories of chronic inflammatory arthritides in children with onset before 16 years of age . Concordin utero from the mother or older siblings during gestation [in utero); and a maternal history of prior fetal loss .Two hypotheses have been suggested relating perinatal and maternal reproductive characteristics to JIA. The “Hygiene hypothesis” suggests that early exposure to infection results in decreased risk of childhood autoimmune disease  due to mestation . Microchestation , and somestation –17 althoestation . Proxy mLacking direct indicators of early prior infection relevant to the hygiene hypothesis, or of the presence of microchimerism, we explored associations of JIA and its individual categories in relation to selected maternal reproductive and infant characteristics as proxies for these, as assessed by birth certificate data among children with, and without JIA. Elucidation of these relationships will enhance understanding of possible JIA risk factors.N = 2,274) and linked to WA State birth records to identify children born in-state . Controls were randomly selected in a 4:1 control: case ratio from remaining birth records, matched on year of birth .This case-control study identified JIA cases at a regional children’s hospital in the Seattle-Puget Sound region of Washington State using methods described previously . ApproprChart review further refined JIA identification and categorized cases into ILAR categories including: polyarticular rheumatoid factor (RF) positive, polyarticular RF negative, oligoarticular arthritis (persistent and extended), psoriatic JIA, enthesitis related arthritis, systemic JIA, and undifferentiated JIA. We excluded 228 cases who did not meet ILAR criteria , and 38 Exposure information from birth records included: birthweight ; size-for-gestational-age ; and gestational age . Maternal and infant factors relevant to the hygiene hypothesis included: number of prior births; delivery method  section), infant birthweight, gestational age and size for gestational age. To examine the microchimerism hypothesis, we examined birth order , plurality , and number of prior fetal losses .Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs) for associations, adjusted for maternal age, and the matching variable birth year. Other factors evaluated for possible effects on the relationships of interest included paternal age; maternal race/ethnicity, educational level, prenatal smoking, and marital status; medical insurance at birth (Medicaid vs. other); sex; and trimester prenatal care began. We adjusted for factors that altered the OR by greater than 10% in univariate analyses. Potential effect modifiers were evaluated by inspection of stratum-specific ORs and the Breslow-Day test for homogeneity. Trends were evaluated using Wilcoxon rank sum test. Analyses were initially conducted to examine JIA overall, and repeated for JIA categories (restricted to factors with at least 5 subjects in a cell). Analyses were conducted using Stata .The majority of cases (67%) were female. Mothers of cases’ were more likely to be white 81%), married (80% v), college graduates (34%), have first trimester prenatal care (86%) and less likely to have Medicaid insurance (26%)  and enthesitis-related arthritis   for one prior birth, to 0.32 (95% CI: 0.15–0.71) for 4+ prior deliveries (p for trend =0.0001), and a suggestion of trend for extended oligoarthritis. Non-statistically significant decreased ORs were observed for greater numbers of prior deliveries for most other JIA categories, except for RF-  and RF+  polyarthritis.ORs were increased in relation to maternal fetal loss for psoriatic JIA ; RF- polyarthritis ; RF+ polyarthritis ; systemic JIA  and enthesitis-related arthritis . Increased ORs were noted with maternal history of early fetal loss (<20 weeks) for enthesitis-related arthritis , RF- polyarthritis , and psoriatic .in utero and during post-natal life. Additionally a modest, non-statistically significant increased risk of JIA with Cesarean delivery similar to a Swedish registry report [We observed a decreased risk of JIA overall in relation to greater maternal parity, with a significant monotonic trend for persistent oligoarthritis, and suggestion of decreased ORs in relation to increasing maternal parity for most other JIA categories. This finding may be consistent with the hygiene hypotheses as children with older siblings likely have greater opportunity for infection exposure, both y report  providesy report .Consistent with our data, a previous Australian clinic-based study showed that having any siblings (vs. none) was protective for JIA in ; a result slightly attenuated  when community controls were used . An OR oThe presence of microchimerism might increase or decrease JIA risk based on the nature of the acquired genetic material. An inverse association of JIA with greater maternal parity may be related to the presence of acquired genetic material carrying JIA-protective Human Leukocyte Antigen (HLA) alleles from an older sibling. In our study, most JIA category-specific risk estimates for maternal fetal loss were increased; a finding that could be consistent with the microchimerism hypothesis only if presence of increased levels of acquired microchimerism from a mother’s prior pregnancy carried JIA-associated risk HLA alleles . HoweverIn contrast with previous studies from Sweden and United States , 6, highPrevious studies related to a gestational age effect vary. Although Swedish registry data suggest a borderline decreased OR in relation to preterm delivery , Shenoi The use of outpatient and inpatient medical records maintained by board-certified pediatric rheumatologists at a large regional children’s medical center, with data linkage to state birth records, are major strengths of this study enabling identification of a relatively large number of cases. Exposure information was assessed from birth records prior to onset and diagnosis of JIA, and was not subject to recall bias. Because of the known polygenic genetic predispositions and heterogeneity of the pathogenesis of differing JIA categories, it is important to examine these relationships separately for each category; to our knowledge, this is the first study to do so. Medical chart review allowed us to confirm and ascertain JIA categories, thereby reducing misclassification.Some limitations of our study include possible inaccuracies in reporting of mother’s reproductive history; in particular, inaccurate reporting of fetal loss on the birth certificates may have lead to non-differential misclassification, biasing the OR estimates towards the null. Birthweight and number of prior live births, however, have been assessed as reliable in comparison to medical records . There iWe observed decreased JIA risk with increasing parity, which potentially supports the hygiene or microchimerism hypotheses, with consistent results demonstrated in many JIA categories. Of note, our results indicate the need to consider JIA categories as separate entities; indeed our results were often inconsistent across categories, suggesting potentially different etiologies. Given the current lack of preventative or curative treatments for JIA, further studies, particularly those capable of examining category-specific JIA associations, are warranted. A better understanding of these associations will help inform prevention programs and hopefully reduce the burden of this debilitating disease.


Acanthamoeba spp. are protist pathogens and causative agents of serious infections including keratitis and granulomatous amoebic encephalitis. Its ability to convert into dormant and highly resistant cysts form limits effectiveness of available therapeutic agents and presents a pivotal challenge for drug development. During the cyst stage, Acanthamoeba is protected by the presence of hardy cyst walls, comprised primarily of carbohydrates and cyst-specific proteins, hence synthesis inhibition and/or degradation of cyst walls is of major interest. This review focuses on targeting of Acanthamoeba cysts by identifying viable therapeutic targets. Acanthamoeba spp. are opportunistic free living amoebae, commonly found in water and soil. Acanthamoeba exist in two forms: (i) an active trophozoite stage and (ii) a resistant double-walled cyst stage , a painful sight-threatening infection, and granulomatous amoebic encephalitis (GAE), a rare but fatal infection of the central nervous system resulting in death in more than 95% of cases [Acanthamoeba keratitis infections includes a combination of antimicrobial agents such as biguanides and diamidines, while in some cases a topical azole and/or neomycin is added in combination [Acanthamoeba infections is the sturdy nature of the cysts and their resistance to physical and chemical damage. Herein, we describe strategies that can be utilised to target Acanthamoeba cysts.age Fig. . Encystmnts etc. . Acanthaof cases . AK is gof cases . AK is sof cases . The curbination –8. BasedAcanthamoeba cysts are double-walled, consisting of an ectocyst and an endocyst. The ectocyst is formed during the initial stage of encystment and appears as an amorphous, discontinuous layer while the endocyst has a fine granular texture, and is uniformly thicker as compared to the former [Acanthamoeba cysts, and it is reported that the endocyst consists of polysaccharides, mainly cellulose, while the ectocyst consists of a mixture of proteins and polysaccharides [Acanthamoeba cyst walls contain 33% proteins, 4–6% lipids, 35% carbohydrates (mostly cellulose), 8% ash, and 20% unidentified material [Acanthamoeba castellanii belonging to the T4 genotype identified galactose as a major constituent of the cyst wall, instead of glucose [Acanthamoeba cyst walls, in addition to the perceived cellulose  as the only target to degrade Acanthamoeba cysts. The use of enzymatic catalysts that can hydrolyse complex sugars can serve as potential agents to target cyst walls via degradation of specific sugar linkages. Once cyst walls are degraded, it is easier to target Acanthamoeba. This concept was proven by our team [Acanthamoeba cysts with cellulase enzyme in combination with chlorhexidine can effectively abolish Acanthamoeba cyst viability. In contrast, cellulase or chlorhexidine alone had limited effects against Acanthamoeba cysts [Bacillus spp. is specifically shown to degrade β-1-6 galactofuranoside linkages in the polysaccharide of Fusarium spp. [Acanthamoeba cyst walls contains about 48% galactose [Acanthamoeba cysts. Such enzymes of glycoside hydrolase class may serve as potential agents to target cyst walls due to their specificity towards degrading gal-glu and gal-gal linkages. Furthermore, the non-toxicity of these enzymes to mammalian cells makes them an ideal candidate for evaluation of cyst-degrading agents. Among carbohydrate-targeting drugs, research in diabetes has received the most attention. A plethora of drugs are available and/or have been tested for antidiabetic effects that function by metabolizing sugars and/or inhibit their synthesis. As some of the compounds may exhibit broad-spectrum activity, it is reasonable to determine their effects against carbohydrate-linked polymer and/or its synthesis in the cyst walls of Acanthamoeba. In particular, as cyst walls of Acanthamoeba contain glucose as another major constituent, the glycogen-targeting antidiabetic drugs may be of value in testing against cyst walls synthesis. Although antidiabetic drugs are consisting of a variety of functional agents such as glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, sulfonyl ureas, insulin, incretin mimetic etc. to name a few, the depletion of cyst walls by deconstruction of sugar linkages or inhibiting polymer synthesis is worth investigating. Sulfonyl ureas such as glimepiride, biguanides such as metformin, glucosidase inhibitors such as acarbose, meglitinides such as glucuronidation agents, DPP4 inhibitors such as vildagliptin, insulin secreting compounds and its biomimetics such as cinnamic acid and its derivatives, should be tested against Acanthamoeba cysts. Furthermore, the other major composite of cyst walls consists of acid-resistant proteins [A. castellanii and its biosynthesis is regulated at the mRNA level [Acanthamoeba cyst protein [Acanthamoeba taxonomy via specific binding to CSP21 [Acanthamoeba which suggests newer entities for targeting protein pathways. Based on MALDI-TOF/TOF analysis, two proteins from trophozoites were identified as hypothetical protein ACA1 and eukaryotic porin protein, while another pair of proteins were identified from cysts as chaperone protein DnaK and chaperonin protein, respectively. The exact functions of these proteins are not fully understood so far, but their anticipated roles are suggested to be as follows: eukaryotic porin proteins may have important role in the efflux of toxic metabolites and exudates during encystment and may also have an effect on pathogenicity. Similarly, proteins such as chaperone protein DnaK and chaperonin protein which belongs to heat shock proteins class, may have a role in folding of cyst specific proteins in cysts [Acanthamoeba.e former . As the charides , 11. Acamaterial . Among c glucose . The car glucose . These four team  who showba cysts . As the ba cysts  establisba cysts . Hence, ium spp. . Similaralactose , targetiproteins . It is aNA level . The dev protein , 17. Forto CSP21 , 17. Behto CSP21  carried in cysts . Hence, Acanthamoeba infections are considered rare, the development of antiacanthamoebic agents faces an even worse scenario when compared to other communicable diseases. The discovery of various antiacanthamoebic compounds tested in vitro has not been able to enter mainstream drug development due to their limited in vivo potential as well as general inefficacy against the cyst stage. A comprehensive review by our team [Acanthamoeba although their in vivo efficacy remains undetermined. A few cases of re-purposing drugs are also reported to work well against Acanthamoeba, including some antibacterial agents: polymyxin B [Acanthamoeba [Acanthamoeba [The recent decline in development of newer antimicrobial agents has contributed to increased disease burden as well as mortality rate and drug resistance . As Acanour team  identifiymyxin B , 22, cefymyxin B , meropenymyxin B , moxifloymyxin B ; antifunymyxin B , azoles ymyxin B , 28; andymyxin B , 30. Ourthamoeba . These ithamoeba –35.Acanthamoeba are so far limited to only a few examples. In our study liposomal complexation of pentamidine isethionate and ergosterol is shown to enhance its antiacanthamoebic activity [Pterocaulon balansae is used as a treatment of ocular AK. The extract is shown to contain high ratio of coumarin compounds which are naturally occurring plant products [Acanthamoeba and possibly their cyst. The conjugation of chlorhexidine with gold nanoparticles has demonstrated a significant increase in its amoebicidal and cysticidal potency, with minimal associated host cell cytotoxicity by our group [2, Fe2O3, ZnO etc. are frequently used as antimicrobial agents due to their capability to generate reactive oxygen species (ROS) in the presence of UV light, which makes them an ideal candidate for application against microbes via photochemotherapy [Acanthamoeba infections. Furthermore, if constructed with cyst-targeting agents such as those discussed here, along with drug conjugation, they may produce effective nanomedicine formulations against Acanthamoeba. For example, if antimicrobial agents are coated on the surface of nanoparticles and those particles are fabricated with reagents having affinity with mannose-binding proteins, cellulose, galactose-polymer, polyhexamethylene biguanide (PHMB), neomycin, and other aforementioned compounds, this may result in enhanced overall antiacanthamoebic activity.Nanotechnology is currently serving as a pivotal tool in different scientific ventures. Its applications in chemistry and biology have exceptionally emerged as potential source of novel solutions. The drastic contrast in chemical and biological properties of nanomaterials, as compared to their bulk counterparts, have pave their path in biomedicines for applications such as diagnosis, therapy, drug delivery etc. Nanomaterials can be simply described as materials and devices which lie within the range of nanometer scale . The mosactivity . In anotactivity . A formuproducts . This reur group . Metal ootherapy . Based oAcanthamoeba infections. These avenues should provide tremendous advantages over non-specific therapies due to minimal side effects and host cells cytotoxicity. The targeted chemotherapy against Acanthamoeba has received limited attention, and only a few reports are published making it an open field for further research. For example, monoclonal IgA antibodies were shown to protect against AK, while the mode of protection was the inhibition of adhesion of Acanthamoeba to the corneal epithelium [Acanthamoeba is an efficient target for delivery of mannose-conjugated drugs. A porphyrin molecule conjugated with mannose was used successfully in our study for the development of photodynamic therapy (PDT) against Acanthamoeba [Acanthamoeba remains a major concern. Additionally, more effective photosensitizers which can generate a burst of toxins at shorter pulsed interval of light will add practicality in their clinical applications. Hence, further work is needed to conjugate Acanthamoeba antibodies with more effective photoactivated compounds and/or drugs in the development of better antiacanthamoebic strategies. Another challenge in the successful treatment of amoebal brain infection is the inefficacy of drugs to cross the BBB to reach the site of infection and target the parasite. Cheng et al. [Acanthamoeba as well as against other CNS pathogens. However, along with drug development, drugs administration also plays a significant role in the effectiveness of their performance, hence there is a desperate need to revisit the overall drug designing protocol against Acanthamoeba infections for efficient and more practical options.Targeting vehicles such as antibodies for a specific antigen, peptides enabling cells penetration and crossing barriers such as the blood-brain barrier (BBB), parasite specific biosynthetic pathways enzymes inhibitors, and mannose-conjugated antimicrobial agents, are important strategies for the targeted delivery of chemotherapeutic agents against ithelium . Drugs cthamoeba . PDT is g et al.  developeg et al. . These sAcanthamoeba infections are complex biological disorders associated with very high rate of morbidity and mortality which require therapeutic strategies that recognize and respond to their dynamic nature. The molecular target-inspired approaches such as those presented above, in our opinion represent appealing frontiers for research and need to be evaluated further to develop more effective therapeutic options against Acanthamoeba as a whole and in particular against its cyst stage.In summary,


Background: Recently, we demonstrated that in healthy newborn infants cerebral blood volume (CBV) was decreasing continuously after birth. We hypothesized that this was due to the increase in oxygen delivery to the brain during neonatal transition. Thus delayed cerebral oxygen delivery in infants in need for respiratory support (RS) during postnatal stabilization might influence changes in CBV.Objective: Aim of the study was to evaluate transitional changes in CBV immediately after birth in term and preterm infants with and without need of RS.Methods: We performed a post-hoc analysis of data collected as primary and secondary outcome parameters in prospective observational studies and randomized controlled trials at the Medical University of Graz (Austria). NIRS measurements by using “NIRO 200-NX”  were carried out over the first 15 min after birth in term and preterm infants delivered by cesarean section with and without requirement for RS.Results: In 204 neonates, we observed a significant decrease in CBV within the first 15 min after birth (p < 0.001) with a trend toward smaller ΔCBV in neonates receiving RS (p = 0.097) compared to neonates without RS. Differences of ΔCBV between groups reached statistically significance (p < 0.05) at minutes 2, 6, and 7, and showed a trend (p < 0.1) at minutes 3, 4, and 5. After adjusting for gestational age, these differences became smaller and failed to reach significance.Conclusions: We observed a significant decrease of CBV in term and preterm infants with and without RS. Interestingly, ΔCBV was smaller in the first 7 min in neonates with RS reaching statistically significance (p < 0.05) at minutes 2, 6, and 7. This study cannot differentiate, whether RS itself or the condition leading to requirement for RS is responsible for the observed CBV behavior. Hemodynamic disturbances have been shown to potentially result in alterations of cerebral perfusion and subsequent brain injury in newborn infants –3. This The use of near-infrared spectroscopy (NIRS) during immediate neonatal transition enables a non-invasive method to evaluate cerebral hemodynamics. Most of the previously published NIRS studies in newborns during neonatal transition reported exclusively on cerebral tissue oxygenation , 5–15. H2 and pCO2 may influence CBV, but compromised cerebral perfusion might further be caused by an increased pulmonary resistance and decreased cardiac output due to over-distension of alveoli and compression of pulmonary capillaries (Newborn infants receiving respiratory support (RS) during postnatal stabilization show a delayed increase in oxygen delivery , which pillaries . This inpost-hoc analysis of data collected as primary and secondary outcome parameters in three prospective observational studies and one randomized controlled trial at the Medical University of Graz; Austria  was provided via face mask of appropriate size  according to the guidelines –21 eitheansition .2) and HR, were continuously monitored by using pulse-oximetry measured on the right wrist . The measurements were conducted over the first 15 min after birth. Singular measurements of blood pressure and rectal body temperature were recorded between minute 10 and 15 after birth and displayed on the “IntelliVue MP30/X2” monitor .As soon as possible, scientific staff members attached the NIRS transducer on the newborn's right forehead by using gauze bandage without disturbing routine medical care. NIRS measurements were carried out with a “NIRO 200-NX” tissue oxygenation monitor . By using NIRS, cerebral tissue oxygenation index (cTOI) and changes in ΔHbT were measured with a sample rate of 2 Hertz. Additionally both, preductal arterial oxygen saturation .In each neonate, ΔHbT values for each minute after birth were calculated by subtracting the mean ΔHbT value at minute 15 from the mean ΔHbT value of the related minute. The 15 min value was used as reference value, because at that time point NIRS signal quality was most stable and reliable. Next, ΔHbT values were converted to ΔCBV by the following equation, whereby Hb represents the hemoglobin concentration (g/dl) :For the calculation either the actual Hb level of the individual (from routinely performed blood sampling within 30 min after birth) or the averaged group Hb of term or preterm infants  was used.t-test or Mann–Whitney U-test, as appropriate. Data of ΔCBV, cTOI, SpO2, and HR are presented as mean and 95% confidence interval (95%CI). We investigated the courses of ΔCBV, cTOI, SpO2, and HR within the first 15 min after birth using a linear mixed model with fixed effects for time, RS (with RS vs. without RS), and gestational age (preterm vs. term). Since most of preterm neonates (82.2%) required RS and most of term neonates (88.1%) did not receive RS, we tested a model including RS without considering gestational age (model 1) and a model including RS and gestational age (model 2). The decision which of these models to be used was based on a REML-based likelihood ratio test. In all models a first order autoregressive covariance structure was used. The autoregressive covariance structure assumes a systematically decreasing correlation with increasing distance between time points. Therefore, adjacent time points will have the highest correlations. Post-hoc analyses for differences between groups for each minute were performed for the comparison of RS groups (with RS vs. without RS) and if model 2 was chosen also for gestational age groups (term infants vs. preterm infants). If model 1 (without comparison: term infants vs. preterm infants) was chosen, the model 2 is given in the supplement together with the model 1. A p-value < 0.05 was considered statistical significant. Statistical analyses were performed using SPSS Statistics 20.0.0 .Demographic variables are presented as absolute and relative counts, mean, and standard deviation (SD) or median and interquartile range (IQR), as appropriate. Comparisons of categorical baseline characteristics between infants with and without RS and between preterm and term infants were made using chi-square test, 2 were different in each subject. RS started at 2.5 (4.0) min, duration of RS within the first 15 min of life was 11.5 (9.0) min [median (interquartile range)].In total, in 204 neonates measurements were performed during the study period including 45 preterm infants (37 with and 8 without RS) and 159 term infants (19 with and 140 without RS) born at a mean gestational age of 33+3 weeks (±15 days) and 38+6 weeks (±6 days), respectively. Thus, 56 newborn infants received RS during the transitional period, whereas 148 had a normal neonatal transition without the need of RS. As RS was according to individual needs of the infants, start points and duration of PPV and/or CPAP and extent of FiODemographic and clinical data of newborn infants with and without RS during immediate postnatal transition are summarized in Table Demographic and clinical data of preterm and term infants—irrespective of whether RS was applied or not—are summarized in Table p < 0.001). Furthermore we observed a trend toward smaller ΔCBV in neonates with RS (p = 0.097), while the courses of ΔCBV were comparable between groups (p = 0.655). Differences of ΔCBV between groups reached statistically significance (p < 0.05) at minutes 2, 6, and 7. The ΔCBV values at minutes 3, 4, and 5 showed a trend (p < 0.10) toward a difference between groups , meaning that gestational age could not explain further differences in ΔCBV between neonates. Nevertheless, gestational age was included in a sensitivity analysis, which resulted in comparable effects  and SpO2 values (p < 0.001) showed a significant increase during immediate postnatal transition. We found significant differences in cTOI and SpO2 levels between newborn infants with and without RS after birth showing significantly lower values in those infants who received RS . By comparing both groups, cTOI levels did not equalize before the 9th minute of age, whereas the differences of SpO2 continued until the end of the observational period of 15 min after birth . While courses of cTOI were comparable between term and preterm infants (cTOI: p = 0.379) SpO2 showed significant different courses between term and preterm infants (SpO2: p = 0.031) with a slightly steeper increase in term infants at the end of the observational period  in the study population. This significant increase was mainly due to an increase within the first 5 min after birth. HR values were higher in newborn infants with RS compared to newborn infants without RS (p = 0.007) . Courses of HR were comparable between term and preterm infants (p = 0.218)  after birth CBV was decreasing, CBV basically remained unchanged in preterm infants receiving one to three sustained lung inflations followed by PPV or CPAP during immediate transition . Based oHowever, it has been shown that initial RS immediately after birth is a considerable risk factor for cerebral injury and local brain inflammation in newborn neonates, particularly in preterm infants who already are at a high risk due to brain immaturity . Even thFirst, all the included infants were delivered by cesarean section and cord clamping was routinely performed 30 s after birth. Therefore it remains unclear, whether vaginal birth or delayed cord clamping would have resulted in a different CBV behavior.NIRS assessment of the frontal cortical region by using a single transducer covers only a small part of the brain in supine positioned infants, although less likely, we cannot rule out that dynamics of CBV during transition might be different in different regions of the brain.2 or pCO2 values, which might have been beneficial for the interpretation of the CBV results.Furthermore, the conversion of NIRS derived ΔHbT to ΔCBV requires the individual Hb levels of every single patient. Unfortunately, it wasn't possible to obtain Hb levels in each patient, because the Regional Committee on Biomedical Research Ethics did not authorize blood sampling exclusively for study purposes. Therefore, in absence of the individual levels we used mean Hb values of the respective study group for calculating ΔCBV. Moreover, we cannot provide continuous pONext, since groups differed in their gestational age, the influence of the gestational age on the primary could not be sufficient investigated. The influence of gestational age on ΔCBV should be a topic of further research.post-hoc analysis need to be interpreted with caution and confirmation by other appropriately designed prospective studies is required.Last, our results derived by We observed a significant decrease of CBV in both groups, in infants undergoing normal transition and in infants in need for RS (either PPV or CPAP). Interestingly, ΔCBV was smaller in the first 7 min in neonates with RS. This study did not yet determine, whether RS itself or the condition of the infant leading to requirement for RS is responsible for the observed differences in CBV compared to healthy newborn infants, but we would hypothesize, that differences in cerebral oxygen delivery may explain this best. Our results are of particularly great interest, since hemodynamic disturbances resulting in changes in cerebral perfusion are discussed to be an important pathway to ventilator-induced brain injury occurring as early as ventilation is initiated in the delivery room.BS, GP, CB-H, NB-S, and BU: substantial contributions to the conception or design of the work; BS, GP, AA, and BU: the acquisition, analysis, or interpretation of data for the work; BS, GP, CB-H, NB-S, AA, and BU: drafting the work or revising it critically for important intellectual Content; BS, GP, CB-H, NB-S, AA, and BU: final approval of the version to be published; BS, GP, CB-H, NB-S, AA, and BU: agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Adolescent pregnancy carries a higher risk of adverse birth outcomes. Currently, there are very few longitudinal studies that have investigated the growth of children born to adolescents. This study explores the birth outcomes and determinants in adolescent pregnancies with subjects enrolled from the Taiwan Birth Cohort Study (TBCS).Using the data of Wave I (6 months old), II (18 months old), and III (36 months old) of TBCS, a national sample of 19,381 pairs of mothers and their children were included for analysis. Out of these subjects, therewere560 pairs of adolescent mothers and children. Through completed field interviews with structured questionnaires, surveys with mothers or other family members, and with references to each child's birth certificate and Passport of Well-baby Care, the differences in birth outcomes, personal, pregnancy, and social profiles of the mothers were analyzed.A total of 560 adolescent mothers (<20 years old) and 18,821 adult mothers (20–34 years old) were included in this study. There was no significant difference between the two groups in terms of parameters of children growth and development. The numbers (proportions) of failure in milestones at 3 years old in gross motor functions, fine motor function, language, and social/personal development of children born to adolescent mothers are 13(2.32), 34(6.07), 10(1.79), and 24(4.29 %), respectively; while there are 392(2.08), 1015(5.39), 308(1.64) and 512(2.72 %) for those born to adult mothers, respectively. The risk factors of failure in children development were identified as “the mother isn't the night-time caregiver” and “family dysfunction”.There was no significant difference in development at 3 years old among children born to adolescent and adult mothers. Adolescent pregnancy carries a higher risk of adverse birth outcomes. Currently, there are very few longitudinal studies that have investigated the growth and development of children born to adolescents. This study explores the birth outcomes and determinants in adolescent pregnancies, using subjects drawn from the Taiwan Birth Cohort Study (TBCS).Children born to adolescent mothers have higher rate of premature birth, low birth weight, and other adverse birth outcomes . HoweverThe study was conducted using the data from a population-based TBCS that included a total of 24,200 pairs of mothers and newborns in 2005. This TBCS provides a wide range of longitudinal information regarding the children’s development. Infants with major disorders and congenital birth defects were excluded from this study. The study was reviewed and approved by the Medical Ethics Committee and Data Protection Board in Taiwan prior to commencement. After obtaining written informed consents, all eligible subjects (mother-child dyads) were categorized into two groups according their maternal ages at the time of delivery. The consent study subjects included878 adolescent mothers (≤20 years at the time of the child’s birth) and 20,370 adult mothers (aged 20 or older).th month) for all children up to 6 years of age . The weights and lengths or heights measurements were performed by trained nurses and recorded to the nearest 100 g and millimeter (mm), respectively. Feeding practice was described by a categorical variable and included as a time-dependent variable to assess its association with growth rate.Data was collected by trained research assistants with the use of a structured questionnaire given during home interviews. The first and secondary home interviews with the 24,200 post-partum women were conducted at birth, 6, 18 and 36 months after their deliveries, during the period from June 2005 to December 2008. A total of 19,910 women completed the interviews, where the response rate was 82.27 %. Aside from mother and infant related information, family related information were also collected using the APGAR scale that was developed by Smilkstein et al., where scores from 0 to 7 were determined as family dysfunction. Information related to birth characteristics, including birth weight, birth order, gender, gestational age, head circumference, birth number (singleton or multiple pregnancy), method of delivery, patterns of infant feeding, and caregiving status were obtained. All of the weight, and length or height measurements were retrieved from the “Child Health Handbook”, which is the documented record of periodic health examinations  . The catGross motor functions:—“Can walk on their own without falling”Fine motor function:—“Can use pen-like objects for drawing random patterns”Language:—“Can imitate adult conversations”Social/personal:—“Can imitate actions performed by others”Development Completion Definitions: Completed by a 3-year-old infantt-test reported at a 0.05 significance level. Means, medians, standard deviations, frequencies, and percentages were calculated for descriptive data. Trend and differences in growth for body weight, body height, and head circumference among babies born to adolescent and adult mothers were analyzed using repeated measure analysis of variance (ANOVA) and Z test statistics, which is comparable across subject ages and provides a more sensitive assessment of deviations of growth. The variables of growth and the change of growth with time from birth to 18 months old were analyzed through a generalized estimating equation (GEE) modeling approach. The definition was used for logistic regression analysis to evaluate the association among growth and each of the dependent variables.Statistical analysis was performed using Statistical Analysis System (SAS) version 9.2 for Windows . Categorical variables are presented as count and percentage, where further comparisons were performed with chi-squared test or Fisher's exact test. Continuous variables are summarized by mean and standard deviation, and compared with a two-tailed independent sample P < 0.001). The major statistical significant demographic differences between adolescent and adult mothers were: primary night-time caregiver  and family dysfunctions . Furthermore, 64.7 % of adolescent mothers have been the caregivers of their infants up to 18 months, which was statistically significantly higher than the adult mothers.According to the TBCS database, in 2005, 4.13 % of newborns were born to adolescent mothers (Table P < 0.001), no difference was observed at36 months. Similarly, the difference in BW was only observed at birth, and was not different at 36 months . Therefore, more maternal detailed information should be investigated in future studies. Therefore, the development of postpartum depression must be especially noted. Finally, we look forward to this continual investigation as the focus of the TBCS shifts toward children development  beyond the age of 3.There is no observable different among children born to adolescent and adult mothers at 3 years of age. Further study will be performed to understand future developmental changes and differences. We conclude that there is no significant difference in developmental characteristics of children born to adolescent mothers at 3 years of age, thus a further long-term investigation is warranted. Finally, additional factors such as father and other family information will be investigated.ANOVA, analysis of variance; BW, body weight; BH, body height; DDST, Denver Development Screening Test; GEE, generalized estimating equation; mm, millimeter; TBCS, Taiwan Birth Cohort Study; SAS, Statistical Analysis System


Violence by intimate partner during pregnancy has many adverse pregnancy outcomes. Thus, that's why we sought to determine association between intimate partner violence during pregnancy and adverse birth outcomes.A facility based cross-sectional study was conducted among 183 recently delivered women from March 31–April 30, 2014 in public health facilities of Hossana Town. The data were collected through structured questionnaire and record review. Women who were not mentally and physically capable of being interviewed and those admitted for abortion were excluded. Ethical clearance was obtained from Jimma University. Logistic regression analysis was employed to determine the association between intimate partner violence and adverse birth outcomes.About 23 % of women experienced intimate partner violence during pregnancy. The result of this study indicated an association of intimate partner violence with low birth weight of the new born . Intimate partner violence was not associated with still birth, pre-term birth and Apgar score less than 7 at 5 minutes.The findings of this study showed that intimate partner violence during pregnancy was associated with a low birth weight of the new born. Health sectors should train health care providers on how to screen, counsel, treat and follow up abused women. Intimate partner violence consists the use of physical, sexual or emotional abusive acts and controlling behaviours. An especially concerning form of physical violence during pregnancy is when abusive partners target a woman's abdomen which can cause hurting the woman and potentially jeopardizing the pregnancyThe prevalence of intimate partner violence during pregnancy among ever-pregnant women ranged from approximately 2% in Australia, Denmark, Cambodia and Philippines to 13.5% among ever-pregnant women in Uganda. More than half of the surveys had a prevalence estimate between 3.8% and 8.8%. However; prevalence appeared to be higher in the African and Latin American countries relative to the European and Asian countries though estimates within regions and countries were highly variableDomestic violence is common in Ethiopia in both urban and rural families. About 68% women agree that wife beating is justified in at least one of the specified situationsIntimate partner violence during pregnancy has been found to be associated with adverse birth outcomes. The risk of being with born low birth weight and pre-term are associated with intimate partner violence. The effect of being born with low birth weight and preterm can result in immediate and long term health and developmental problems. The effects are not limited to women who experience only physical abuse; even psychological abuse has been linked to poor birth outcomes. Physical, mental health problems and negative health behaviours are some of maternal factors that are associated with intimate partner violence during pregnancyA longitudinal study demonstrates that maternal antenatal stress predicts children's behavioural and emotional problems four years later, with the underlying mechanism including the effect of maternal mood on the fetal brain development, which affects the child's behavioural developmentWomen who were reporting physical, sexual and emotional violence were more likely to deliver by caesarean section and to have abnormal progress of labour, premature rupture of membranes, low birth weight baby, preterm birth and any hospitalization before delivery than women who did notA meta-analysis of 30 studies on maternal exposure to abuse and birth outcomes found that maternal exposure to domestic violence was significantly associated with an increased risk of low birth weight, as well as an increased risk of preterm birthUnderstanding the relationship between violence during pregnancy and adverse birth outcomes could have important clinical and public health implications. Early identification and intervention to prevent violence against pregnant women might reduce adverse birth outcomes. In Ethiopia, information on effects of intimate partner violence on birth outcomes is limited. Therefore, the aim of this research was to determine association between intimate partner violence during pregnancy and adverse birth outcomes among recently delivered women in public health facilities of Hossana Town.The study was conducted in Hossana Town, which is situated in Hadiya zone of South nation's nationalities regional state of Ethiopia. The Town is located 232 Kilometres far from Addis Ababa. In Hossana Town, there are three governmental health centres, one governmental hospital, and 25 private health facilities. The study was conducted in public health facilities. According to the information of Hadiya zone health department, 2,176 women gave birth in the four public health facilities of Hossana Town in 2013. The proportion of birth attended by health professional in the town was 27% in 2013. The study period lasted from March 31–April 30, 2014.Women who were giving birth in public health facilities of Hossana Town were recruited as source population for this study. The study population was all women who recently gave birth irrespective of whether the pregnancy outcome was alive or still birth. Women who were not mentally and physically capable of being interviewed and those admitted for abortion or for other pregnancy complications and later discharged undelivered were excluded in this study.Facility based cross sectional study was conducted among 195 recently delivered women in public health facilities of Hossana Town. The required number of sample was allocated proportionally among the four public health facilities. Consecutive sampling technique was undertaken by taking every woman who was presented in selected health facilities until allocated sample size was reached.Pre-tested structured questionnaire and record review checklist were used to collect data from the study subjects. The questions were adopted from WHO multi-country study on domestic violenceThe data collection instrument comprises of socio-demographic and economic factors, experience of intimate partner violence during pregnancy, and record review checklist. The record reviews were conducted on delivery summary book of each respondent. The data collected on new born outcomes included alive birth, still birth, birth weight, Apgar score at 5 minutes, term and preterm birth.Four female nurses and two supervisors' were recruited as interviewers and as supervisors respectively. Data collectors and supervisions were trained for one day on interviewing techniques, purpose of the study and ethical aspects.The principal investigator and supervisor made a day to day on site supervision during the whole period of data collection and checked each questionnaire daily for its completeness and consistency.Intimate partner was considered as current husband, co-habited , or boyfriend. Prevalence of intimate partner violence during pregnancy was measured by any act of physical, sexual or psychological abuse during last pregnancy by intimate partner.We defined intimate partner violence according to the WHO Multi-Country StudySexual violence includes any of one or more .Psychological violence includes any of one or more . Overall prevalence of intimate partner violence was measured by any act of physical, sexual or psychological violence during last pregnancy.Adverse birth outcomes were measured by low birth weight, preterm birth, still birth or Apgar score <7 at 5 minutes. Low birth weight was defined as a live birth weighing < 2500 grams. Preterm was defined as a neonate born before 37 completed weeks. The cut off points used for the birth outcomes were based on standardsData were entered into Epi-data version 3.1 Multivariate logistic regression was performed to assess the relationship between intimate partner violence during pregnancy and adverse birth outcomes with adjustments for potential confounders. Confounding was assessed by entering potential confounders into a logistic model at a time, and then compared the unadjusted and adjusted ORs. We considered the following variables as possible confounders in these analyses. These were age of women, planned pregnancy, educational status, occupation, average monthly income, number of children, number of pregnancies and marital status. Final logistic regression models included covariates that altered unadjusted ORs by at least 10%We followed World Health Organization ethical and safety recommendationsInterviewers were trained to be aware of the effects that the questions may have on informants and how best to respond, based on a woman's level of distress. Privacy and confidentiality of the respondents were protected.Of the 195 recently delivered women, 183 (94 %) gave an informed consent and were included in the study. The mean age women were 25.4 (SD ±4.6). Regarding to educational status, 64(35%) attained primary education. Occupation status of respondent's showed that house wife accounted 98(53.6%). One hundred seventy four (95%) of women were married. Ninety two (50.3%) of respondent became pregnant three or more times. For majority of women, 137(75%) their last pregnancy was planned. More than half of respondents 114(62.3%) had one to three children. The mean children women had were 2.8(SD±1.9). The median monthly income of the respondent's was 1200 Ethiopian birr .Forty three (23%) of women experienced at least one form of intimate partner violence during pregnancy. Psychological violence was the most common form 36 (20%) followed by physical 27(15%) and sexual 22 (12%). From physical violence, slapping 27(14.8 %) was the commonest form of violence. Physically forced to have sexual intercourse 22(12%), and insulting 36(19.7) were commonest form of sexual and emotional violence respectively .One hundred eighty three records were reviewed to obtain the birth outcomes of the newborn. Of the 183 births, 175(95.6%) were live births and 8(4.4%) were still births. Of the live births, 39 (22.3%) were low birth weight. Only 16(8.7%) of the new born were preterm. Nine (5%) of new born Apgar scores were less than 7 at 5 minutes. From the total 183 births, 47(25.6%) had at least one adverse birth outcomes and sixteen (34%) had more than one adverse birth outcomes .Association between intimate partner violence during pregnancy and adverse birth outcomes.Bivariate association was done using enter method to identify association between intimate partner violence during pregnancy and adverse birth outcomes. On bivariate analysis, intimate partner violence during pregnancy showed significant association with low birth weight . There was no association between IPV and still birth , Apgar score less than 7 at 5 minutes  and preterm birth (COR=0.36(0.12.1.014).A multivariate analysis was done to see significant association between intimate partner violence during pregnancy and low birth weight. After adjustment for age of women, number of pregnancy, planned pregnancy, educational status of women and monthly income, intimate partner violence during pregnancy was associated with low birth weight. The new born whose mothers were abused during pregnancy were 14.3 times more likely to be having low birth weight as compared to new born whose mothers were not abused during pregnancy  .The overall prevalence of intimate partner violence during pregnancy in current study was 23%. The psychological violence was the most common form (20%) followed by physical (15%) and sexual (12%). This finding is consistent with studies done in other African countries. A review of literature on IPV in African countries found that its prevalence ranges from 2% to 57 %. The overall prevalence of intimate violence during pregnancy in current study is lower than Kenyan study, which showed 37% of women were abused during pregnancyThe prevalence of intimate partner violence during pregnancy in current study is higher than the WHO study of Ethiopia, which revealed 8% of women were abused during pregnancyThe current study has publicized that there is significant association between intimate partner violence during pregnancy and low birth weight of newborn. Studies done in United States of America on maternal exposure to abuse and birth outcomes showed that there was an association of intimate partner violence and low birth weightThe pathway through which violence may lead to risk of adverse birth outcomes has not been fully understood. One possible pathway is the direct effect of blunt physical trauma and subsequent adverse pregnancy outcomeOn the other hand, our study is inconsistent with the study done in PakistanIn current study, Apgar score less than 7 at 5 minutes, still birth and preterm birth were not greater in abused women than non-abused women. This finding is in line with study in Pakistan, which showed that proportion of infant with Apgar score less than 7 at 5 minutes, still birth and preterm birth was not significantly greater in abused women than non-abused womenContrary to current study, study done in Peru and meta-analysis of 30 studies found maternal exposure to domestic violence was significantly associated with an increased risk of preterm birthSince this study was a cross sectional in design, it is difficult to establish causes and effect relationships among outcome of interest and explanatory variable. The sensitive nature of the topic and its proneness to response bias may lead to under-reporting of the true extent of the abuse.Since we collected data from a secondary source there may be quality problems. Factors that can influence birth outcomes such as antenatal follow up, alcoholism, smoking and substance abuse were not collected in the survey, therefore adjusting for these factors was not possible.Since the study was facility based and women who delivered at home were excluded in this study. Because of this reason, applicability of findings to the general population is uncertain. Besides, the wide confidence intervals were observed in this study and it may affect precision. This may be due to small sample size. Hence, interpretation of the finding shall take in to account all the factors mentioned above.The findings of this study revealed that intimate partner violence during pregnancy is associated with adverse birth outcome (low birth weight of new born). Thus, health sectors should train health care providers on how to screen, counsel, treat, and follow up of abused women. The study further calls for longitudinal research regarding the pathway through which violence may lead to risk of adverse birth outcomes.


Objectives Cigarette smoking during pregnancy is an important modifiable risk factor for poor birth outcomes. We evaluated whether participation in a statewide incentive-based smoking cessation program for pregnant women, the Baby & Me-Tobacco Free (BMTF) program, was associated with improved birth outcomes. Methods Linked program and birth certificate data from 866 pregnant smokers who participated in the BMTF program and 11,568 pregnant smokers who were eligible for but did not enroll in the program were analyzed. The BMTF program consisted of 4 prenatal smoking cessation counselling sessions, 12 postpartum follow-up visits, breath carbon monoxide measurements to monitor smoking status, and rewards of diaper vouchers for quitting smoking. Logistic regression models were used to examine the associations of program participation with infant low birth weight and preterm birth. Results Participants who completed 3–4 prenatal smoking cessation sessions had a significantly lower rate of low birth weight than non-participants (4.9 vs. 11.6 %). After adjustment for multiple potential confounders, the odds ratios for low birth weight were 0.51  in those participants completing 3–4 sessions and 0.37  in participants who quit smoking, as compared with non-participants. Although not statistically significant, a protective effect was also suggested for preterm birth. Conclusions We found for the first time that successful participation in the BMTF program, a unique incentive-based smoking cessation program for pregnant women implemented in community settings, was associated with significantly reduced odds of having a low birth weight infant. What is already known on this subject? Although use of financial incentives has been shown to increase smoking cessation in pregnant smokers in randomized controlled trials, data are lacking on the effectiveness of incentive-based smoking cessation programs for pregnant women implemented in “real” world community settings. Moreover, the effects of such programs on birth outcomes remain unclear.What this study adds? This study provides the first evidence that successful participation in a unique statewide incentive-based smoking cessation program tailored to pregnant women, the Baby & Me-Tobacco Free program, was associated with improved birth outcomes.Cigarette smoking during pregnancy is a major modifiable risk factor for poor birth outcomes, including low birth weight, preterm birth, and sudden infant death syndrome . All pregnant women who were current smokers, regardless of their income level, were invited to participate in the BMTF program via flyers and informational sessions at the local health departments and community settings. Program staff underwent structured training, which emphasized the 5A’s approach  and motivational interviewing strategies  was classified as normal (non-smoker) range  and 95 % confidence intervals (CIs) of low birth weight and preterm birth associated with the BMTF program participation, and to adjust for potential confounding factors. Women were classified into 3 groups: non-participants (defined as pregnant smokers who were eligible for but not enrolled in the BMTF program), participants with low prenatal session attendance , and participants with high prenatal session attendance (defined as those who attended 3–4 cessation sessions); the non-participation group served as the reference group. Multivariable analyses were stratified by county of residence and adjusted for maternal age (4 categories), marital status (yes/no), race/ethnicity (4 categories), education level (3 categories), annual household income (3 categories), health insurance (3 categories), number of prenatal care visits (4 categories), WIC participation status (yes/no), pre-pregnancy body mass index (4 categories), and history of pre-gestational or gestational diabetes or hypertension (yes/no). To further evaluate the effects of program engagement and smoking cessation during pregnancy on birth outcomes, we also divided women into non-participants, BMTF participants with no evidence of quitting smoking, and BMTF participants with evidence of quitting smoking on the basis of breath CO measurement. We examined the associations of program engagement and smoking cessation during pregnancy with low birth weight and preterm birth, while adjusting for multiple potential confounders. In addition, we conducted analyses stratified by prior parity status (nulliparous/parous) to examine potential effect modification. Statistical analyses were performed by using SAS statistical software . All statistical tests were based on 2-sided probability.We excluded 69 women with missing data on gestational age or infant birth weight, leaving 12,434 pregnant smokers for final analyses . We compared the distribution of sociodemographic characteristics, public health and medical service utilization, history of cigarette smoking and other risk factors for adverse birth outcomes, and birth outcomes between BMTF participants and non-participants. Table On average, non-participants smoked 17.9 cigarettes per day in the 3 months before pregnancy, and 12.9, 9.6, and 8.4 cigarettes per day during the first, second and third trimesters, respectively (Table ORs and 95 % CIs of low birth weight and preterm birth according to BMTF program participation and smoking cessation during pregnancy are summarized in Tables P for interaction = 0.62). The corresponding ORs for preterm birth were 0.57 (95 % CI 0.26–1.24) and 0.55 (95 % CI 0.26–1.20) among women with and without prior live births, respectively (P for interaction = 0.51).In stratified analyses, we found no statistically significant effect modification of prior parity status on the associations between smoking cessation and birth outcomes. The ORs of low birth weight for participants who quit smoking versus non-participants were 0.25 (95 % CI 0.08–0.79) and 0.27 (95 % CI 0.10–0.75) among women with and without prior live births, respectively  in our study presumably received standard care, which may have contributed to some of the observed variation in their smoking patterns across pregnancy. It is possible that non-participants might also have received other forms of interventions for smoking cessation which we could not account for. Nevertheless, the use of an active comparator would likely strengthen our conclusion.In conclusion, our study found for the first time that successful participation in the BMTF program, an incentive-based smoking cessation program specifically designed for pregnant women, was associated with significantly decreased odds of having a low birth weight infant.


The middle initials of the second, sixth, seventh, and eighth authors are omitted. The correct byline is: Westa Domanova, James R. Krycer, Rima Chaudhuri, Pengyi Yang, Fatemeh Vafaee, Daniel J. Fazakerley, Sean J. Humphrey, David E. James, Zdenka Kuncic. The correct citation is: Domanova W, Krycer JR, Chaudhuri R, Yang P, Vafaee F, Fazakerley DJ, et al. (2016) Unraveling Kinase Activation Dynamics Using Kinase-Substrate Relationships from Temporal Large-Scale Phosphoproteomics Studies. PLoS ONE 11(6): e0157763. 10.1093/bioinformatics/btv550.Reference 35 is incomplete. The complete reference is: Yang P, Humphrey SJ, James DE, Yang YH. Positive-unlabeled ensemble learning for kinase substrate prediction from dynamic phosphoproteomics data. Bioinformatics. 2016. 32(2):252–9.


Ethnic disparities in lung function have been linked mainly to anthropometric factors but have not been fully explained. We conducted a cross-sectional pilot study to investigate how best to study ethnic differences in lung function in young adults and evaluate whether these could be explained by birth weight and socio-economic factors.a priori using linear regression, and used penalised regression to examine a wider range of factors. We reviewed the implications of our findings for the feasibility of a larger study.We recruited 112 university students of White and South Asian British ethnicity, measured post-bronchodilator lung function, obtained information on respiratory symptoms and socio-economic factors through questionnaires, and acquired birth weight through data linkage. We regressed lung function against ethnicity and candidate predictors defined There was a similar parental socio-economic environment and no difference in birth weight between the two ethnic groups, but the ethnic difference in FVC adjusted for sex, age, height, demi-span, father’s occupation, birth weight, maternal educational attainment and maternal upbringing was 0.81L (95%CI: -1.01 to -0.54L). Difference in body proportions did not explain the ethnic differences although parental immigration was an important predictor of FVC independent of ethnic group. Participants were comfortable with study procedures and we were able to link birth weight data to clinical measurements.Studies of ethnic disparities in lung function among young adults are feasible. Future studies should recruit a socially more diverse sample and investigate the role of markers of acculturation in explaining such differences. Attempts to explain these differences have centred on a difference in chest size, for which proxies such as sitting height or the ratio of sitting to standing height  are commonly used [Low lung volume is strongly related to mortality ,2. This  ignored –7. The enly used ,8. HowevThe lower educational and socio-economic status of ethnic minorities compared with White individuals ,10, contHere, we describe a pilot investigation on differences in lung function among young adults from two ethnic groups in the UK, White and South Asian British. We assessed the feasibility of performing such a study, with a particular focus on recruitment rate, willingness to take part, potential missingness of information and the feasibility of linkage with birth weight data from the UK birth registry. We also obtained preliminary results on both ethnic differences in lung function and potential explanatory factors that might account for these differences, focusing on birth weight and socio-economic factors.Recruitment and data collection are described in detail in 1 values were used in the statistical analyses.All clinical measurements (spirometry and anthropometry) were performed according to standard operating procedures. Long bone length (demispan and ulna) were measured twice each  using a Questionnaires were employed to elicit information on respiratory symptoms, smoking, parental and grandparental socio-economic status and educational attainment, parental and grandparental upbringing and place of birth, as well as feedback on the study methods and procedures . Birth wData were summarised using mean and standard deviation for continuous variables or number and percentage for categorical variables, and the proportion of missing data was reported. Differences between the two ethnic groups and differences between those who did and did not have birth weight data were investigated using a t-test or, when necessary, the non-parametric Wilcoxon rank sum test for continuous variables, and, due to the low number of participants, Fisher’s exact test for categorical variables. Estimates of the association of risk factors with respiratory symptoms by ethnicity were expressed in terms of odds ratios.1/FVC were assessed using linear regression. Differences between the two ethnic groups in the outcomes were assessed using multiple linear regression with the covariates sex, age, height, demispan, father’s occupation, birth weight, maternal educational attainment and maternal upbringing specified a priori, on the basis of the existing literature and the experience of the research group. The variance inflation factor was employed to evaluate multicollinearity [Associations with the main outcome of interest, post-bronchodilator FVC, and FEVinearity . As secoIn an additional analysis, we assessed the association of the outcomes of interest with variables beyond those selected a priori , apart from the lasso regression, which was performed using the glmnet package  in R 3.2Ethical approval for the study was obtained from the Imperial College Research Ethics Committee (ICREC 13_6_16) and the Imperial College Medical Education Ethics Committee (MEEC 1314–07). Written informed consent was obtained from each participant.From a target population of 3,863 UK students at Imperial College London, aged 18–23, and of White or South Asian British ethnicity 112 (3%) participants were recruited into the study, with no difference in recruitment by ethnicity . All 112Twenty-six participants provided feedback for the study, of which 23 had attended the study visit (20.5% of those who attended the study visit) and 3 had not (13% of those who provided contact details but did not attend the study visit). The feedback questionnaire showed that all participants reported that they were “very comfortable” with all study procedures, apart from seven reporting to be only “somewhat comfortable” with spirometry . No adveReasons for taking part were equally divided between helping medical research, being interested in knowing their lung function and for the reimbursement . Recruit1 or FEV1/FVC.Of the 112 participants recruited into the study, three White participants that did not fulfil the ancestry inclusion criterion were excluded, while poor lung function test quality excluded a further 10 participants . Birth wThe characteristics of the participants are shown in Most South Asian British participants  were second-generation immigrants (neither parent born in the UK), whereas for the majority of White participants both parents were born in the UK . Parents and grandparents of South Asian British participants were also more likely to have had a rural upbringing compared to White participants. All South Asian British participants had three or more grandparents born in South-Asia, except one participant whose grandparents were born in either South-Asia or East-Africa. Conversely 88% of White British participants had at least three grandparents who were born in the UK (n = 60), while the remaining participants had at least three grandparents who were born in either the UK or Western Europe (n = 6) or were born solely in Western Europe (n = 2).Despite the difference in upbringing and immigration status, the educational attainment of parents or grandparents did not differ between South Asian British and White participants. The occupational status of the parents and grandparents were very similar and no difference was observed in the father’s or mother’s occupation nor in the paternal or maternal grandfathers’ jobs. However, grandmothers of South Asian British participants were much more likely to have never worked outside the home  to 0.81 L (95% CI: -1.01 to -0.54 L)  . Materna-0.54 L) .1/FVC did not show any statistically significant association with ethnicity, sex, age, birth weight or any reported anthropometric or parental measures .The additional analysis with lasso regression identified six predictors of FVC, in addition to ethnicity . These iThis pilot investigation was able to recruit a young adult sample and link their birth weight data to clinical measurements. The study found a difference in FVC despite the similar socio-economic status of the parents and the lack of any difference in birth weight between the two ethnic groups. Thus, it is unlikely that birth weight or socio-economic factors can fully explain the difference in FVC between the two ethnic groups in this study population. Moreover, this pilot investigation found no support for the hypothesis that a difference in body proportions can explain ethnic differences in lung function and identified parental immigration as an important predictor of FVC.1/FVC. These findings are in line with two previous studies, performed in different age groups. In the BOLD London study in British adults older than 40, Hooper et al. found the FVC 0.79 L and 0.49 L lower in South Asian British compared with Whites, for men and women respectively [1/FVC between White and South Asian British subjects was observed in the BOLD London study [1/FVC was reported by Strippoli et al. [This pilot study showed an FVC 0.86 L lower in South Asian compared with White participants, while no difference was observed for FEVIn our study, South Asian British students were 3.6 times more likely to experience wheezing in the last year compared to White students, although we observed no significant difference in doctor-diagnosed asthma between the two ethnic groups or in reversibility of lung function following the administration of bronchodilator . This could be a result of differences in reporting symptoms, due to differences in the perception and experience of wheezing or cultural differences in reporting symptoms. Alternatively, there could be a true difference in environmental and genetic risk factors between the two groups that results in more wheezing among South Asian British students independent of lung function reversibility.Parental and grandparental factors were very similar in the two ethnic groups. No differences in educational attainment of parents and grandparents or in occupational status of parents or grandfathers between the two ethnic groups were observed, though South Asian paternal and grandparental upbringing was more likely to have occurred in a rural environment and South Asian grandmothers were more likely to have been housewives. Although it was rare for both parents of South Asian British participants to be born in the UK, they were professionally and educationally very similar to the parents of the white British students. The study participants from both ethnic groups appear to have grown up in similar socio-economic but different cultural environments. This is in contrast with the low parental socio-economic environment of South Asian British compared to White children in the study by Strippoli et al. . The simWe did not observe a difference in birth weight between the two ethnic groups while Strippoli et al.  found a Long-bone length relative to other aspects of body size, commonly assessed as either the ratio of arm span to height or the ratio of sitting to standing height, has been associated with social advantage and lower mortality –28. HoweThe immigration status of the mother and father were identified by the lasso regression as important predictors of FVC, with their combined effect being larger than the effect estimate for (self-defined) ethnicity. This suggests an environmental influence explaining the difference in lung function between ethnic groups, which is potentially related to cultural factors that would be continuing to have an effect post-migration. However, findings from our lasso analysis should be regarded as preliminary and require further confirmation in future studies. The investigation of factors that might affect the offspring’s lung function and might be associated with parental migration also requires information on the timing of the migration, as this could affect the exposure and duration of exposure.1 at age 9 to 13 years compared to children in the placebo group [1. Subsequently, they reported that a low maternal level of α-tocopherol level was associated with a reduced FVC, possibly mediated by a reduced crown-rump length at the first trimester scan [Potential environmental factors to investigate in future studies include exposure to culturally specific sources of air pollution, such as incense burning or shisha smoking in the home, or other toxins imported from the country of origin, as occurred with the importation of cosmetics such as Kohl, a product that contained high levels of heavy metals –34. Dietbo group . Devakumbo group . Devereubo group  showed iter scan . These ster scan –42.Although exposures continuing after migration are the most likely explanation we cannot exclude epigenetic factors with persistent effects in the offspring born outside the country of origin of the parents, or other exposures during extended visits back to the original family home during childhood, and these need to be recorded carefully in future studies –45. MorePrevious studies investigating the difference in lung function between White and South Asian British participants found marked differences in socio-economic status ,6. HowevParticipation into epidemiological studies has severely declined in the past decades  and onlyCompliance with the study procedures and the completeness of information for the questionnaires were very good. Only a small number of participants were unable to perform acceptable post-bronchodilator lung function after coaching due to poor coordination of in- and exhalation, while other missing data were observed only for questions pertaining to grandparental information. This might be explained by reduced contact with grandparents due to geographic distance or early death.Birth weight linkage was possible for nearly all participants and was provided by NHS Digital from the ONS birth dataset, which is considered the most complete dataset for birth weight information . HoweverDisparities in lung function between ethnic groups have long been recognised, but findings to date have not provided conclusive answers on what might explain them. This pilot investigation showed that it is feasible to study this question among University students and provides the information required to plan a more definitive study. It has identified parental immigration as a potential predictor of FVC, and found no evidence that differences in birth weight or body proportions explained the ethnic differences in lung function. Future studies should widen the social background of participants and focus on markers of acculturation, such as diet, to explain the ethnic differences.S1 Fig(PNG)Click here for additional data file.S2 Fig(PNG)Click here for additional data file.S3 Fig(PNG)Click here for additional data file.S4 FigSome participants indicated multiple reasons for participation and therefore the numbers do not add up to 26.(PNG)Click here for additional data file.S5 Fig(PNG)Click here for additional data file.S1 Text(DOCX)Click here for additional data file.S2 Text(PDF)Click here for additional data file.