Vitamin D concentrations during pregnancy and in cord blood: a systematic review and meta-analysis.

CONTEXT: Effect size estimates for the association between vitamin D concentrations in maternal blood during pregnancy and in cord blood vary widely across studies, but no meta-analysis has been conducted to ascertain this association. OBJECTIVE: The aim of this systematic review was to estimate the pooled effect size for the association between circulating 25-hydroxyvitamin D (25[OH]D) concentrations, a marker of vitamin D status, in maternal blood during pregnancy and in cord blood. DATA SOURCES: The PubMed, Embase, and Web of Science databases were searched from their inception to February 2021. DATA EXTRACTION: Following the application of prespecified inclusion and exclusion criteria, 94 articles were eligible for full-text review, which was conducted by 2 authors independently. A third author was consulted when necessary and consensus reached. In total, 26 articles, which comprised 30 studies and 6212 mother-infant dyads, were included. Methodological quality was assessed using a modified version of the Joanna Briggs Institute's Critical Appraisal Checklist for Studies Reporting Prevalence Data. Correlation coefficient (r) values for the association between maternal serum 25(OH)D concentrations during pregnancy and in cord blood were extracted. DATA ANALYSIS: The r values were pooled using random-effects meta-analyses. Sensitivity and subgroup analyses were performed to investigate sources of heterogeneity. The pooled r for all studies was 0.72 (95%CI, 0.64-0.79), indicating high heterogeneity (I2 = 95%, P < 0.01). After influential and outlier studies were removed, the pooled r for 9 studies was 0.70 (95%CI, 0.66-0.74), which resulted in a substantial reduction in heterogeneity (I2 = 41%, P=0.10). CONCLUSION: The findings support a positive and large correlation between maternal vitamin D concentrations during pregnancy and vitamin D concentrations in cord blood. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42021273348.

What explains the large disparity in child stunting in the Philippines? A decomposition analysis.

OBJECTIVE: About one-third of under-five Filipino children are stunted, with significant socio-economic inequality. This study aims to quantify factors that explain the large gap in stunting between poor and non-poor Filipino children. DESIGN: Using the 2015 Philippine National Nutrition Survey, we conducted a linear probability model to examine the determinants of child stunting and then an Oaxaca-Blinder decomposition to explain the factors contributing to the gap in stunting between poor and non-poor children. SETTING: Philippines. PARTICIPANTS: 1881 children aged 6-23 months participated in this study. RESULTS: The overall stunting prevalence was 38·5 % with a significant gap between poor and non-poor (45·0 % v. 32·0 %). Maternal height, education and maternal nutrition status account for 26 %, 18 % and 17 % of stunting inequality, respectively. These are followed by quality of prenatal care (12 %), dietary diversity (12 %) and iron supplementation in children (5 %). CONCLUSIONS: Maternal factors account for more than 50 % of the gap in child stunting in the Philippines. This signifies the critical role of maternal biological and socio-economic circumstances in improving the linear growth of children.

Trends in National-Level Governance and Implementation of the Philippines' Responsible Parenthood and Reproductive Health Law from 2014 to 2020.

In 2012, the Philippines passed the Responsible Parenthood and Family Planning Law, a landmark legislation billed as a multisectoral and rights-based approach to further sustainable human development. This article is part of the first comprehensive evaluation of the implementation of the law by national-level actors. This evaluation is intended to assess the progress of implementers in the conduct of mandates, roles, and responsibilities described in the law and its implementing guidelines. Interviews with key national government officials and data from official documents and literature revealed 3 major trends in governance and implementation from 2014 to 2020. First, despite being a multisectoral policy, performance was siloed within individual units of implementing agencies, with limited interagency coordination. Second, although the law explicitly called for interventions to invest in human capital and address socioeconomic disparities for sustainable human development, performance focused on biomedical and health interventions, particularly in the area of family planning. Third, national-level governance for reproductive health interventions concentrated on programmatic and operational concerns. Overall, this case in the Philippines illustrates that fragmented implementation has contributed to the slow improvement of reproductive health outcomes. This study highlights the challenges of governance and multisectoral coordination to implement multidimensional interventions in a low- and middle-income country, and it provides potential areas for political and administrative reform in reproductive health governance in the Philippines. By creating a common narrative and onboarding multiple sectors, officials can better identify and address structural determinants with holistic policy solutions to improve reproductive health outcomes.

Gastro-intestinal parasitism and control practices in dairy cattle in North-west Cameroon (Central Africa).

PURPOSE: The main objective of this study was to assess the gastrointestinal parasitism in relation with the worm control practices (WCP) in dairy cattle in areas of major importance for dairy/milk production of Cameroon. METHODS: Fresh fecal samples were randomly collected from 402 cattle from August to October 2016 in North West Cameroon, and analyze using the McMaster technique. Data on WCP were collected using a questionnaire. RESULTS: A total of 11 parasites species were identified: Trichostrongylus sp. (5.97%); Oesophagostomum sp. (5.47%); Haemonchus sp. (2.48%); Bonostomum sp. (1.74); Cooperia sp. (1.49%). Toxocara sp (0.24%); Ostertagia sp. (0.50%); Nematodirus sp. (0.74%); Trichuris sp. (0.50%); Moniezia sp. (0.50%); Eimeria sp. (0.50%). The mean individual parasite load for helminthes and protozoa ranged from 100 to 400 eggs per gram of feces (epg) and 333-400 oocysts per gram of feces (opg), respectively. Most farmers (95.12%) used conventional drugs (Albendazole, Doramectin, Fenbendazole, Ivermectin.) to deworm animals as compared with traditional phytotherapy (e.g., Carica papaya leaves) (4.88%). The mean epg/opg in animals treated with conventional drugs was significantly higher (p < 0.05) than in those receiving traditional treatment. Animals treated less than four times a year with conventional drugs had the highest (p < 0.05) mean epg/opg compared with animals treated four to six times a year. CONCLUSION: This study suggests that treating at least four times a year with conventional drugs, and at least two times a year with traditional approaches could help reducing GIP burden in dairy cattle in North West Cameroon. Since the majority of farmers use conventional drugs, it is imperative for them to appropriately use these conventional drugs for a better control of GIP on their farms.

HIV-related mortality in Jamaican children / Mortalidad relacionada con el VIH en niños jamaicanos

OBJECTIVE: Paediatric HIV is a leading cause of morbidity and mortality worldwide. We describe HIV-related mortality in a cohort of HIV-infected Jamaican children and identified factors which influenced survival. METHODS: A retrospective descriptive study was conducted for the period March 2003 - December 2005 at Cornwall Regional Hospital, Montego Bay, Jamaica. We summarized demographic and clinical data of deceased and living perinatally HIV-infected children and identified factors that influenced survival of rapid and slow progressors. Rapid progressors are HIV-infected children identified clinically before age 2 years and slow progressors after age 2 years. RESULTS: There were 9 (18%) HIV/AIDS-related deaths among 50 HIV-infected children of whom 23 (46%) were males and 21(43%) were AIDS orphans. Five children (10%) received ARV prophylaxis, 31 (62%) were breastfed and 39 (78%) received HAART. Surviving children displayed primarily non-AIDS defining illnesses (pneumonia and sepsis) but there was no difference in AIDS-defining illnesses among living and deceased children. The median age at diagnosis was 26 months (range 3-121; IQR 10,54). The median age at death was 30 months (range 7-122 months; IQR 17,118). Both surviving and deceased children presented with primarily moderate symptoms at diagnosis (21, 42%) and death (7, 78%). In rapid progressors, 19 of 20 (95%) on HAART remained alive and all 4 (100%) who did not receive HAART died. The mortality rate in children on HAART was 30.78 per 100 person years and 48 per 100 person years in children not receiving HAART. CONCLUSIONS: HAART is the only factor identified which prolonged survival for HIV-infected children who are rapid progressors, have AIDS-defining illnesses and are orphans.

OBJETIVO: El VIH pediátrico es la principal causa de morbilidad y mortalidad a nivel mundial. El presente trabajo describe la mortalidad relacionada con el VIH en una cohorte de niños jamaicanos infectados por el VIH y factores identificados que influyeron en la supervivencia. MÉTODOS: Se llevó a cabo un estudio retrospectivo para el período de marzo de 2003 a diciembre 2005 en el Hospital Regional Cornwall, de Montego Bay, Jamaica. Resumimos los datos clínicos y demográficos de los niños infectados por el VIH, tanto de los fallecidos como de los vivos, e identificamos los factores que influyeron en la supervivencia de progresores rápidos y lentos. Los progresores rápidos son niños infectados por el VIH identificados clínicamente antes de los dos años de edad y los preopresores lentos son aquellos identificados después de los dos años de edad. RESULTADOS: Hubo 9 (18%) muertes relacionadas con el VIH/SIDA entre 50 niños infectados por el VIH, de los cuales 23 (46%) eran varones y 21(43%) eran huérfanos del SIDA. Cinco niños (10%) recibieron profilaxis ARV, 31(62%) fueron amamantados y 39 (78%) recibieron TARAA. Los niños sobrevivientes mostraron enfermedades primariamente no definitorias de SIDA (neumonía y sepsis), pero no hubo diferencia en las enfermedades definitorias del SIDA entre los niños vivos y los fallecidos. La edad mediana al momento del diagnóstico fue de 26 meses ( rango 3-121; IQR 10, 54). La edad mediana al momento de la muerte fue de 30 meses (rango 7-122 meses; IQR 17 118). Tanto los niños sobrevivientes como los fallecidos presentaron síntomas primariamente moderados en el momento del diagnóstico (21 para un 42%) y la muerte (7 para un 78%). En los progresores rápidos, 19 de 20 (95%) bajo TARAA continuaron vivos y el total de los 4 (100%) que no recibieron TARAA murieron. La tasa de mortalidad en los niños bajo TARAA fue de 30.78 por cada 100 años-persona y 48 por 100 años-persona en niños que recibieron TARAA. CONCLUSIONES: TARAA es el único factor identificado que prolongó la supervivencia de los niños infectados con el VIH que eran rápidos progresores, tenían enfermedades definitorias del SIDA y eran huérfanos.

HIV-related mortality in Jamaican children.

OBJECTIVE: Paediatric HIV is a leading cause of morbidity and mortality worldwide. We describe HIV-related mortality in a cohort of HIV-infected Jamaican children and identified factors which influenced survival. METHODS: A retrospective descriptive study was conducted for the period March 2003 - December 2005 at Cornwall Regional Hospital, Montego Bay, Jamaica. We summarized demographic and clinical data of deceased and living perinatally HIV-infected children and identified factors that influenced survival of rapid and slow progressors. Rapid progressors are HIV-infected children identified clinically before age 2 years and slow progressors after age 2 years. RESULTS: There were 9 (180%) HIV/AIDS-related deaths among 50 HIV-infected children of whom 23 (46%) were males and 21 (43%) were AIDS orphans. Five children (10%0) received ARV prophylaxis, 31 (62%) were breastfed and 39 (78%) received HAART Surviving children displayed primarily non-AIDS defining illnesses (pneumonia and sepsis) but there was no difference in AIDS-defining illnesses among living and deceased children. The median age at diagnosis was 26 months (range 3-121; IQR 10, 54). The median age at death was 30 months (range 7-122 months; IQR 17, 118). Both surviving and deceased children presented with primarily moderate symptoms at diagnosis (21, 42%) and death (7, 78%). In rapid progressors, 19 of 20 (95%) on HAART remained alive and all 4 (100%) who did not receive HAART died. The mortality rate in children on HAART was 30.78 per 100 person years and 48 per 100 person years in children not receiving HAART. CONCLUSIONS: HAART is the only factor identified which prolonged survival for HIV-infected children who are rapid progressors, have AIDS-defining illnesses and are orphans.

Professional discourse and service cultures: an organisational typology developed from health and welfare services for people with learning disabilities.

This study focuses upon the effect of social policy upon a particular area of service provision. It is influenced by the Foucauldian concept of governmentality and the proposition by Lewis et al. that social policy needs to be understood in local contexts. Only through understanding the partial and fragmented impact of policy can we gain a clear insight into the outcomes for users. The study is undertaken through an exploration of the micro politics of organisations providing health and welfare services for people with learning disabilities. It involves an approach to discourse analysis that focuses upon text developed from interviews with service providers, which is brought into contact with published literature in an iterative process. The interpretation of the text produces four themes: power, trust, citizenship and managerialism. The development of these themes and a further holistic interpretation of the text suggest an emerging organisational typology. A typology based upon different articulations of the themes noted that work to produce particular outcomes for service users.

Complete cDNA encoding human phospholipid transfer protein from human endothelial cells.

Phospholipid transfer protein, with an apparent molecular mass of 81 kDa, was purified from human plasma. The NH2-terminal amino acid sequence of a 51-kDa proteolytic fragment obtained from phospholipid transfer protein allowed degenerate primers to be designed for polymerase chain reaction and the eventual isolation of a full-length cDNA from a human endothelial cDNA library. The cDNA is 1,750 base pairs in length and contains an open reading frame of 1,518 nucleotides encoding a leader of 17 amino acids and a mature protein of 476 residues. Northern blot analysis shows a single mRNA transcript of approximately 1.8 kilobases with a wide tissue distribution. The gene was mapped to chromosome 20 using a human/rodent somatic cell hybrid mapping panel. Phospholipid transfer protein was found to be homologous to human cholesteryl ester transfer protein, human lipopolysaccharide-binding protein, and human neutrophil bactericidal permeability increasing protein (20, 24, and 26% identity, respectively).

Isolation of glucagon antagonists by random molecular mutagenesis and screening.

Glucagon has an important role in the regulation of glucose homeostasis, and glucagon antagonists may be effective therapeutic agents in the control of diabetes mellitus. We were able to identify a number of analogs with antagonist activity by creating libraries of mutant glucagon coding sequences, expressing them in a yeast (Saccharomyces cerevisiae) secretion system, and screening for clones that produce analogs that inhibit the glucagon stimulation of rat hepatocyte membrane adenylate cyclase. These libraries were constructed by allowing random misincorporation during the synthesis of oligonucleotides that contained the complete coding sequence for mammalian glucagon or for an analog (desHis1-glucagon) that had partial antagonist activity. We developed and used a simplified screening assay to test culture broths from > 3500 individual transformant yeast clones for their ability to inhibit glucagon-dependent adenylate cyclase activity. Ultimately, > 20 different analogs with antagonist activity were identified by recovering and sequencing plasmid DNA from yeast strains that were positive in the screening assay. Interestingly, several analogs were identified repeatedly in independent yeast clones and certain amino acid substitutions occurred in more than one analog. This clustering of randomly isolated mutations clearly delineates the regions of the glucagon molecule that are important for designing improved glucagon antagonists. A subset of the antagonists identified in yeast broth were produced by peptide synthesis to confirm their activities as pure compounds.

Expression, purification, and characterization of human factor XIII in Saccharomyces cerevisiae.

Factor XIII is the terminal enzyme of the clotting cascade. A cDNA sequence encoding human placental factor XIII was expressed in Saccharomyces cerevisiae with the yeast ADH2-4c promoter. Expression levels were a strong function of the noncoding flanking DNA content of the construction. When the terminal 3'-flanking noncoding DNA was removed, expression increased approximately 50-fold. The protein was produced in quantity by high-yield fermentation and purified to homogeneity. The recombinant protein was cleaved by thrombin at the same activation site as purified human placental FXIII and exhibited 100% enzymatic activity. At high thrombin concentrations rFXIIIa was cleaved into inactive 54- and 25-kDa polypeptides. The identity of these cleavage sites and the blocked N-terminus to that of the human protein was revealed by amino acid microsequencing. A time course of thrombin activation was performed and the relative distribution of the thrombin-cleaved subunits to the uncleaved zymogen subunits determined; the results were consistent with the half of the sites catalytic model for transglutaminase activity proposed by Chung et al. (Chung, S. I., Lewis, M. S., & Folk, J. E. (1974) J. Biol. Chem. 249, 940-950, 1974) and Hornyak et al. (Hornyak, T. J., Bishop, P. D., & Shafer, J. A. (1989) Biochemistry 28, 7326-7332). Equilibrium and velocity sedimentation analysis indicated that rFXIII exists as a 166-kDa nondissociating dimer that behaves as a compact particle of 8.02 S. Thus, all of the properties of rFXIII thus far examined are consistent with those reported for human platelet and placental FXIII.(ABSTRACT TRUNCATED AT 250 WORDS)

Hypothalamic thermoregulatory pathways in the rat.

The cutaneous blood flow (mbl), rate of oxygen consumption (Vo2), rectal (Tre) and cutaneous (Tsk) temperatures, and shivering activity were measured in unanthetized male rats during a 2-h exposure to 26, 33, or 5 degrees C 2 wk after selective bilateral hypothalamic microknife cuts. Animals with preoptic-anterior hypothalamic (PO/AH) junction cuts 1.5 or 3.0 mm lateral to the midline, as well as parasagittal cuts which separated connections between the PO/AH and medial forebrain bundle exhibited a higher mbl at 26 degrees C than did sham-operated rats. At 5 degrees C the extended (3.0 mm) PO/AH cuts as well as the parasagittal cuts prevented cutaneous vasoconstriction but had no effect on shivering activity; hence Tre was not maintained. None of the cuts demonstrably impaired thermoregulation in the 33 degrees C environment. These results suggest that different sites in the hypothalamus may separately control cold-induced skin vasoconstriction and shivering activity, as well as heat-induced skin vasodilation. It would seem therefore that the integrity of the PO/AH is indispensable in rats for cold-induced cutaneous vasoconstriction but not for cold thermogenesis, and also not for heat-induced cutaneous vasodilation.