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Search Results: 1 - 10 of 359081 matches for " HARLOW SIOBáN D. "
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Mortalidad infantil y marginación urbana: análisis espacial de su relación en una ciudad de tama?o medio del noroeste mexicano
álvarez,Gerardo; Lara,Francisco; Harlow,Siobán D.; Denman,Catalina;
Revista Panamericana de Salud Pública , 2009, DOI: 10.1590/S1020-49892009000700005
Abstract: objective: to identify areas with high risk of infant mortality and any possible correlation with the population’s socioeconomic status through the use of a geographicinformation system and spacial analysis techniques. methods: an exploratory ecologic study was conducted in hermosillo, the capital of sonora, mexico, in 2000-2003. the urban marginalization index (umi) and the infantmortality rate (imr) were determined for each of the city’s basic geostatistical areas(bga). the umi and imr were statistically calculated to identify geographic areas inwhich they were concentrated and to determine the degree of spatial correlation between these indicators. to determine the general spatial autocorrelation and spatialclustering of umis and imrs within the city and the bgas, morans i index, ipop statistics, and besag and newell’s method were employed. results: the mean imr was 14.3 per 1000 live births, higher in the bgas withgreater social marginalization (16.2 per 1000) and lower in those with less (11.7 per 1000). the umi range was -3.1-6.6 (maximum: 4.3; minimum: -2.7). autocorrelation was found among the umi (moran i = 0.62), with significant clustering in the city’s northwest, northeast, and southeast parts. local clustering of high imrs was found in hermosillo’s central and western areas, albeit without autocorrelation (moran i = -0.007). high risk areas (high imr and high umi) were found in the city’s north-western section. conclusions: spatial clusters with high imr were found in socially marginalizedareas in the northwestern part of hermosillo, a city of medium size located in north-western mexico. these results, reached through a combination of spatial analysistechniques and geographic information tools can help guide interventions specifically designed for these high risk residential areas.
Environmental Risk Score as a New Tool to Examine Multi-Pollutants in Epidemiologic Research: An Example from the NHANES Study Using Serum Lipid Levels
Sung Kyun Park, Yebin Tao, John D. Meeker, Siobán D. Harlow, Bhramar Mukherjee
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0098632
Abstract: Objective A growing body of evidence suggests that environmental pollutants, such as heavy metals, persistent organic pollutants and plasticizers play an important role in the development of chronic diseases. Most epidemiologic studies have examined environmental pollutants individually, but in real life, we are exposed to multi-pollutants and pollution mixtures, not single pollutants. Although multi-pollutant approaches have been recognized recently, challenges exist such as how to estimate the risk of adverse health responses from multi-pollutants. We propose an “Environmental Risk Score (ERS)” as a new simple tool to examine the risk of exposure to multi-pollutants in epidemiologic research. Methods and Results We examined 134 environmental pollutants in relation to serum lipids (total cholesterol, high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL) and triglycerides) using data from the National Health and Nutrition Examination Survey between 1999 and 2006. Using a two-stage approach, stage-1 for discovery (n = 10818) and stage-2 for validation (n = 4615), we identified 13 associated pollutants for total cholesterol, 9 for HDL, 5 for LDL and 27 for triglycerides with adjustment for sociodemographic factors, body mass index and serum nutrient levels. Using the regression coefficients (weights) from joint analyses of the combined data and exposure concentrations, ERS were computed as a weighted sum of the pollutant levels. We computed ERS for multiple lipid outcomes examined individually (single-phenotype approach) or together (multi-phenotype approach). Although the contributions of ERS to overall risk predictions for lipid outcomes were modest, we found relatively stronger associations between ERS and lipid outcomes than with individual pollutants. The magnitudes of the observed associations for ERS were comparable to or stronger than those for socio-demographic factors or BMI. Conclusions This study suggests ERS is a promising tool for characterizing disease risk from multi-pollutant exposures. This new approach supports the need for moving from a single-pollutant to a multi-pollutant framework.
Incidence of stillbirth and perinatal mortality and their associated factors among women delivering at Harare Maternity Hospital, Zimbabwe: a cross-sectional retrospective analysis
Shingairai A Feresu, Siobán D Harlow, Kathy Welch, Brenda W Gillespie
BMC Pregnancy and Childbirth , 2005, DOI: 10.1186/1471-2393-5-9
Abstract: Using information available in obstetric records for all deliveries (17,072 births) at Harare Maternity Hospital, Zimbabwe, we conducted a cross-sectional retrospective analysis of a one-year data, (1997–1998) to assess demographic and obstetric risk factors for stillbirth and early neonatal death. We estimated risk of stillbirth and early neonatal death for each potential risk factor.The annual frequency of stillbirth was 56 per 1,000 total births. Women delivering stillbirths and early neonatal deaths were less likely to receive prenatal care (adjusted relative risk [RR] = 2.54; 95% confidence intervals [CI] 2.19–2.94 and RR = 2.52; 95% CI 1.63–3.91), which for combined stillbirths and early neonatal deaths increased with increasing gestational age (Hazard Ratio [HR] = 3.98, HR = 7.49 at 28 and 40 weeks of gestation, respectively). Rural residence was associated with risk of infant dying in utero, (RR = 1.33; 95% CI 1.12–1.59), and the risk of death increased with increasing gestational age (HR = 1.04, HR = 1.69, at 28 and 40 weeks of gestation, respectively). Older maternal age was associated with risk of death (HR = 1.50; 95% CI 1.21–1.84). Stillbirths were less likely to be delivered by Cesarean section (RR = 0.64; 95% CI 0.51–0.79), but more likely to be delivered as breech (RR = 4.65; 95% CI 3.88–5.57, as were early neonatal deaths (RR = 3.38; 95% CI 1.64–6.96).The frequency of stillbirth, especially macerated, is high, 27 per 1000 total births. Early prenatal care could help reduce perinatal death linking the woman to the health care system, increasing the probability that she would seek timely emergency care that would reduce the likelihood of death of her infant in utero. Improved quality of obstetric care during labor and delivery may help reduce the number of fresh stillbirths and early neonatal deaths.Perinatal mortality remains a challenge in the care of pregnant women worldwide, particularly in developing countries [1-3]. To address the problem of per
Sociodemographic and nutritional correlates of neurobehavioral development: a study of young children in a rural region of Ecuador
Handal,Alexis J.; Lozoff,Betsy; Breilh,Jaime; Harlow,Siobán D.;
Revista Panamericana de Salud Pública , 2007, DOI: 10.1590/S1020-49892007000400004
Abstract: objective: to identify and describe the sociodemographic and nutritional characteristics associated with neurobehavioral development among young children living in three communities in the northeastern andean region of cayambe-tabacundo, ecuador. methods: women in the study communities who had a child 3 to 61 months of age completed a questionnaire about maternal and child health and sociodemographic characteristics. the ages and stages questionnaire (asq) was directly administered to 283 children by two trained interviewers. growth measurements and a hemoglobin finger-prick blood test were obtained in 2003-2004. prevalence of developmental delay was calculated, and associations between child development and maternal, child, and household characteristics were explored. results: high frequencies of developmental delay were observed. children 3 to 23 months old displayed delay in gross motor skills (30.1%), and children 48 to 61 months old displayed delay in problem-solving skills (73.4%) and fine motor skills (28.1%). a high frequency of both anemia (60.4%) and stunting (53.4%) was observed for all age groups. maternal educational level was positively associated with communication and problem-solving skills, and monthly household income was positively associated with communication, gross motor, and problem-solving skills. conclusions: the results suggest a high prevalence of developmental delay and poor child health in this population. child health status and the child's environment may contribute to developmental delay in this region of ecuador, but sociodemographic factors affecting opportunities for stimulation may also play a role. research is needed to identify what is causing high percentages of neurobehavioral developmental delay in this region of ecuador.
Quality of cause-of-death statements and its impact on infant mortality statistics in Hermosillo, Mexico
álvarez,Gerardo; Harlow,Siobán D.; Denman,Catalina; Hofmeister,Mary J.;
Revista Panamericana de Salud Pública , 2009, DOI: 10.1590/S1020-49892009000200004
Abstract: objectives: this study evaluates the quality (completeness and accuracy) of cause-of-death (cod) statements in infant death certificates as entered into a vital records system and as sesses its impact on infant mortality statistics in hermosillo, sonora, mexico. methods: cod statements in a systematic random sample of 200 infant death certificates were compared to their corresponding medical charts. the underlying cods (ucods) orig inally recorded in each death certificate were contrasted with those assigned by an expert re viewer. coding for the original and "new" ucods was based on the three-digit category of the international classification of diseases, 10th revision. measurements of agreement be tween the two sets of ucods were calculated and logistic regression was performed to deter mine factors associated with agreement. results: overall agreement between the original and new ucods was 52%. agreement was excellent for the group of deaths due to congenital malformations, deformations, and chro mosomal abnormalities (kappa = 0.77); substantial for conditions originating in the perinatal period (kappa = 0.74); and poor for certain infectious and parasitic diseases, and respiratory diseases (kappa = 0.35). overestimation (false-positive reporting) was highest (13%) for peri natal conditions, while underestimation (false-negative reporting) was highest (71%) for cer tain infectious and parasitic diseases, and respiratory diseases. agreement was associated with type of ucod (endogenous versus exogenous) and time of death. conclusion: more than half (53%) of cod statements in infant death certificates in her mosillo were inaccurately completed, which may lead to inaccurate interpretation of causes of infant mortality. systematic assessments of the quality of cod statements may improve the quality of mortality statistics.
Validity of underlying cause of death statistics in Hermosillo, Mexico
Carvalho,Mary H Freire de; álvarez-Hernández,Gerardo; Denman,Catalina; Harlow,Siobán D;
Salud Pública de México , 2011, DOI: 10.1590/S0036-36342011000400005
Abstract: objective: this paper assesses the quality of the underlying cause of death (cod) statistics in hermosillo, mexico in a random sample of 300 in-hospital adult deaths. material and methods: a "gold standard" cod, determined by a systematic review of hospital medical charts, was compared to the cod reported by the vital registry system. results: overall agreement between the reviewer and original cod at the icd-10 chapter block was 69.2%, with a weighted kappa of 0.62. agreement varied greatly by icd-10 chapter. mutual misclassification among common co-morbidities,such as diabetes mellitus and circulatory disease, minimized the net change in the mortality fraction assigned to each icd-10 chapter after physician review. conclusions: the icd-10 chapter level underlying cod codes can be used to estimate disease burden in the population. caution is recommended for use of vital registry statistics in hermosillo for individual level or disease-specific analyses.
An Integrated Quantitative Methodology to Longitudinally Characterize Complex Dynamic Processes Associated with Ovarian Aging and the Menopausal Transition
Huiyong Zheng,Maryfran Sowers,John F. Randolph, Jr.,Siobán D. Harlow
Journal of Systemics, Cybernetics and Informatics , 2011,
Abstract: An integrative methodology is developed to characterize the complex patterns of change in highly variable dynamic biological processes. The method permits estimatation of the population mean profile, multiple change points and length of time-windows defined by any two change points of interest using a semi-/non-parametric stochastic mixed effect model and a Bayesian Modeling Average (BMA) approach to account for model uncertainty. It also allows estimation of the mean rate of change of sub-processes by fitting piecewise linear mixed effect models. The methodology is applied to characterize the stages of female ovarian aging and the menopausal transition defined by hormone measures of estradiol (E2) and follicle stimulating hormone (FSH) from two large-scale epidemiological studies with community-based longitudinal designs and ethnic diversity.
Condiciones de trabajo materno y bajo peso al nacer en la Ciudad de México
CERóN-MIRELES,PRUDENCIA; SáNCHEZ-CARRILLO,CONSTANZA IVETTE; HARLOW,SIOBáN D.; Nú?EZ-URQUIZA,ROSA MARíA;
Salud Pública de México , 1997, DOI: 10.1590/S0036-36341997000100002
Abstract: objective. to study the association between maternal working conditions and low birth-weight in mexico city. material and methods. interviews of 2 623 workers who gave birth in mexico city hospitals during 1992 were analyzed. information on the main biologic and social factors associated to low birth-weight was registered. occupational stress was determined with the instrument designed by karasek. logistic regression models to evaluate the relationship between working conditions and low birth-weight were used, controlling by confounding variables. results. low birth-weight was more frequent in workers with working periods of more than 50 h/week (or= 1.6; 95% ci= 1.17, 2.28) and with problems at work (or= 1.5; 95% ci= 1.0, 2.25). lack of tangible social support was identified as a risk factor for low birth-weight (or= 1.7; 95% ci= 1.20, 2.33). preventive working measures such as changes in tasks, shortening of working hours and leaves of absence due to illness did not show a beneficial effects on birth-weight, except for the maternity leave of absence. mothers with no right to this had a 2.2 higher probability of giving birth to low weight children (95% ci= 1.66, 2.93). conclusions. these results emphasize the importance of identifying the occupational risk factors during pregnancy.
Condiciones de trabajo materno y bajo peso al nacer en la Ciudad de México
CERóN-MIRELES PRUDENCIA,SáNCHEZ-CARRILLO CONSTANZA IVETTE,HARLOW SIOBáN D.,Nú?EZ-URQUIZA ROSA MARíA
Salud Pública de México , 1997,
Abstract: Objetivo. Estudiar la asociación entre condiciones de trabajo materno y bajo peso al nacer en la Ciudad de México. Material y métodos. Se encuestaron 2 623 trabajadoras que atendieron sus partos en tres grandes hospitales de la Ciudad de México en 1992. Se obtuvo información sobre los principales factores biológicos y sociales que se asocian al bajo peso al nacer; asimismo, se determinó el estrés ocupacional utilizando el instrumento desarrollado por Karasek. Se utilizaron modelos de regresión logística para evaluar la relación de las condiciones de trabajo con el bajo peso al nacer, controlando por variables confusoras. Resultados. El bajo peso al nacer fue más alto en trabajadoras con jornadas mayores a 50 horas semanales (RM= 1.6; IC= 1.17, 2.28) y con conflictos laborales (RM= 1.5; IC= 1.0, 2.25). La falta de apoyo social tangible fue identificado como un factor de riesgo de bajo peso al nacer (RM= 1.7; IC= 1.20, 2.33). Las medidas preventivas laborales como el cambio de tareas, disminución de la jornada y las salidas por enfermedad no mostraron un efecto benéfico en el peso al nacer, a excepción de la licencia de maternidad; las madres que no la tuvieron mostraron una probabilidad 2.2 veces mayor para bajo peso al nacer (IC= 1.66, 2.93). Conclusiones. Estos hallazgos resaltan la importancia de identificar los factores de riesgo ocupacional en el embarazo..
Neighborhood socio-environmental vulnerability and infant mortality in Hermosillo, Sonora
Lara-Valencia,Francisco; álvarez-Hernández,Gerardo; Harlow,Siobán D; Denman,Catalina; García-Pérez,Hilda;
Salud Pública de México , 2012, DOI: 10.1590/S0036-36342012000400006
Abstract: objective: this paper explores the impact of contextual variables at the neighborhood level on a health marker in the city of hermosillo, mexico and discusses the importance of collaboration between planners and health professional to minimize the negative effect of contextual factors on urban health. materials and methods: few studies in mexico have assessed health outcomes at the intra-urban scale and their interaction with neighborhood-level contextual variables. using spatial analysis and geographical information systems, the paper explores the association between infant mortality and an index of socio-environmental vulnerability used to measure urban contextual factors. results: two high infant mortality clusters were detected within neighborhoods characterized by relatively good environmental conditions and one in a neighborhood with a poor environment. conclusions: our results show the clustering of high infant mortality areas and some association with built environment factors in hermosillo. the results support the need to reconnect public health and urban planning as a way to create healthier environments in mexican cities.
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