Postneonatal Infant Mortality Research Articles

Reflections on a Career in Pediatric Neuropathology, with a Note of Gratitude.

I am honored to be asked by the journal to write this personal essay about my career in pediatric neuropathology-a life of immense satisfaction, meaning, and fulfillment. My motivation to enter this discipline is highlighted, as is my decision to perform brain research in the sudden infant death syndrome, the leading cause of postneonatal infant mortality in the United States today. I also touch upon collaborations, mentoring, and experiences along the way-especially with the light microscope. I close with thoughts about the future of the discipline from my perspective as a lifelong devotee.

Dysregulation of platelet serotonin, 14–3–3, and GPIX in sudden infant death syndrome

Sudden infant death syndrome (SIDS) is the leading cause of post-neonatal infant mortality, but the underlying cause(s) are unclear. A subset of SIDS infants has abnormalities in the neurotransmitter, serotonin (5-hydroxytryptamine [5-HT]) and the adaptor molecule, 14–3–3 pathways in regions of the brain involved in gasping, response to hypoxia, and arousal. To evaluate our hypothesis that SIDS is, at least in part, a multi-organ dysregulation of 5-HT, we examined whether blood platelets, which have 5-HT and 14–3–3 signaling pathways similar to brain neurons, are abnormal in SIDS. We also studied platelet surface glycoprotein IX (GPIX), a cell adhesion receptor which is physically linked to 14–3–3. In infants dying of SIDS compared to infants dying of known causes, we found significantly higher intra-platelet 5-HT and 14–3–3 and lower platelet surface GPIX. Serum and plasma 5-HT were also elevated in SIDS compared to controls. The presence in SIDS of both platelet and brainstem 5-HT and 14–3–3 abnormalities suggests a global dysregulation of these pathways and the potential for platelets to be used as a model system to study 5-HT and 14–3–3 interactions in SIDS. Platelet and serum biomarkers may aid in the forensic determination of SIDS and have the potential to be predictive of SIDS risk in living infants.

Altered 5-HT2A/C receptor binding in the medulla oblongata in the sudden infant death syndrome (SIDS): Part I. Tissue-based evidence for serotonin receptor signaling abnormalities in cardiorespiratory- and arousal-related circuits.

The sudden infant death syndrome (SIDS), the leading cause of postneonatal infant mortality in the United States, is typically associated with a sleep period. Previously, we showed evidence of serotonergic abnormalities in the medulla (e.g. altered serotonin (5-HT)1A receptor binding), in SIDS cases. In rodents, 5-HT2A/C receptor signaling contributes to arousal and autoresuscitation, protecting brain oxygen status during sleep. Nonetheless, the role of 5-HT2A/C receptors in the pathophysiology of SIDS is unclear. We hypothesize that in SIDS, 5-HT2A/C receptor binding is altered in medullary nuclei that are key for arousal and autoresuscitation. Here, we report altered 5-HT2A/C binding in several key medullary nuclei in SIDS cases (n = 58) compared to controls (n = 12). In some nuclei the reduced 5-HT2A/C and 5-HT1A binding overlapped, suggesting abnormal 5-HT receptor interactions. The data presented here (Part 1) suggest that a subset of SIDS is due in part to abnormal 5-HT2A/C and 5-HT1A signaling across multiple medullary nuclei vital for arousal and autoresuscitation. In Part II to follow, we highlight 8 medullary subnetworks with altered 5-HT receptor binding in SIDS. We propose the existence of an integrative brainstem network that fails to facilitate arousal and/or autoresuscitation in SIDS cases.

Maternal Opioid Use Disorder and the Risk of Postneonatal Infant Mortality

The risk of serious long-term outcomes for infants born to individuals with opioid use disorder (OUD) is not fully characterized, nor is it well understood whether risks are modified by infant diagnosis of neonatal opioid withdrawal syndrome (NOWS). To characterize the risk of postneonatal infant mortality among infants with a NOWS diagnosis or born to individuals with OUD. The study team conducted a retrospective cohort study of 390 075 infants born from 2007 through 2018 to mothers who were enrolled in Tennessee Medicaid from 183 days prior to delivery through 28 days post partum (baseline). Maternal and infant baseline characteristics were measured using administrative claims and birth certificates, and infants were followed up from day 29 post partum through day 365 or death. Deaths were identified using linked death certificates through 2019. These data were analyzed from February 10, 2022, through March 3, 2023. Infant exposures included birth to an individual with OUD or postnatal diagnosis of NOWS. The study team defined a pregnant individual's OUD status (maternal OUD) as having OUD diagnosis or a maintenance medication prescription fill during baseline; this study defined NOWS as having NOWS diagnosis up to day 28. Groups were categorized by exposures as maternal OUD with NOWS (OUD positive/NOWS positive), maternal OUD without NOWS (OUD positive/NOWS negative), no documented maternal OUD with NOWS (OUD negative/NOWS positive), and no documented maternal OUD or NOWS (OUD negative/NOWS negative, unexposed). The outcome was postneonatal infant death, confirmed by death certificates. Cox proportional hazards models were used, adjusting for baseline maternal and infant characteristics, to estimate adjusted hazard ratios (aHRs) and 95% CIs for the association between maternal OUD or NOWS diagnosis with postneonatal death. Pregnant individuals in the cohort had a mean (SD) age of 24.5 (5.2) years; 51% of infants were male. The study team observed 1317 postneonatal infant deaths and incidence rates of 3.47 (OUD negative/NOWS negative, 375 718), 8.41 (OUD positive/NOWS positive, 4922); 8.95 (OUD positive/NOWS negative, 7196), and 9.25 (OUD negative/NOWS positive, 2239) per 1000 person-years. After adjustment, the risk of postneonatal death was elevated for all groups, relative to the unexposed: OUD positive/NOWS positive (aHR, 1.54; 95% CI, 1.07-2.21), OUD positive/NOWS negative (aHR, 1.62; 95% CI, 1.21-2.17), and OUD negative/NOWS positive (aHR, 1.64; 95% CI, 1.02-2.65). Infants born to individuals with OUD or with a NOWS diagnosis had an increased risk of postneonatal infant mortality. Future work is necessary to create and evaluate supportive interventions for individuals with OUD during and after pregnancy to reduce adverse outcomes.

Health risk assessment for particulate matter: application of AirQ+ model in the northern Caribbean region of Colombia

Air pollution is considered the world’s most important environmental and public health risk. The annual exposure for particulate matter (PM) in the northern Caribbean region of Colombia between 2011 and 2019 was determined using PM records from 25 monitoring stations located within the area. The impact of exposure to particulate matter was assessed through the updated Global Burden of Disease health risk functions using the AirQ+ model for mortality attributable to acute lower respiratory disease (in children ≤ 4 years); mortality in adults aged > 18 years old attributable to chronic obstructive pulmonary disease, ischaemic heart disease, lung cancer, and stroke; and all-cause post-neonatal infant mortality. The proportions of the prevalence of bronchitis in children and the incidence of chronic bronchitis in adults attributable to PM exposure were also estimated for the population at risk. Weather Research and Forecasting-California PUFF (WRF-CALPUFF) modeling systems were used to estimate the spatiotemporal trends and calculate mortality relative risk due to prolonged PM2.5 exposure. Proportions of mortality attributable to long-term exposure to PM2.5 were estimated to be around 11.6% of ALRI deaths in children ≤ 4 years of age, 16.1% for COPD, and 26.6% for IHD in adults. For LC and stroke, annual proportions attributable to PM exposure were estimated to be 9.1% and 18.9%, respectively. An estimated 738 deaths per year are directly attributed to particulate matter pollution. The highest number of deaths per year is recorded in the adult population over 18 years old with a mean of 401 events. The mean risk in terms of the prevalence of bronchitis attributable to air pollution in children was determined to be 109 per 100,000 inhabitants per year. The maximum RR values for mortality (up 1.95%) from long-term PM2.5 exposure were predicted to correspond to regions downwind to the industrial zone.

Risk of Postneonatal Infant Mortality Associated With Prior Founded Allegations of Child Abuse.

Context: There are ∼7500 postneonatal deaths (28 days to under 1 year) in the US annually, of which a majority are preventable. Previous studies have reported a child's prior encounter with child protective services (CPS) as a risk factor for preventable death but few studies have evaluated this in relation to subsequent postneonatal deaths. Objective: To measure the association between prior reports of child abuse and subsequent postneonatal death. Study Design/Analysis: Secondary data analysis from the case-control Chicago Infant Mortality Study (CIMS). Conditional logistic regression modeling determined the odds of postneonatal death when there was a founded prior allegation. Setting and Population Studied: CIMS included all sudden, unexplained infant deaths up to 1 year in Chicago (November 1993-April 1996) (n=469), and matched living controls (n=472). Information on prior child abuse reports and outcomes was obtained through the Illinois Department of Children and Family Services (DCFS) State Central Registry for each case and control. Instrument: Cause of death was determined by Cook County Medical Examiners based on autopsy, death scene investigation and review of the medical history. DCFS database was searched on infant's name, mother's name, screening number and other identifiers. Only "founded" allegations that occurred prior to the date of death (cases) and date of interview (controls) were included Outcome measures: Founded allegations for cases by cause of death. Odds of death by prior allegations and other socio-demographic factors. Results: DCFS founded allegations were identified in 119 cases (25%) and/or their families and in 35 controls (7%; OR = 4.25, 95% CI, 2.86, 6.35). There were no clear patterns when frequency of allegations was analyzed by cause of death. Families with founded allegations were almost 4 times more likely to experience a postneonatal death (aOR =3.79, 95% CI, 1.56, 9.10). Lower maternal education, age, inadequate prenatal care and infant-parent bedsharing were also associated with higher odds of postneonatal death. Conclusions: Child protective services involvement is an opportunity for education to help reduce the incidence of potentially preventable infant deaths. Families should have access to appropriate acute and preventive care and receive ongoing education about child abuse prevention, infant safety, reducing the risk of preventable deaths such as SIDS, and when to seek medical attention.

Environmental Risk Assessment from 2018 To 2022 for Kota, Rajasthan (India)

Particulate matter pollution in the metropolis has become an international concern because of its dangerous short and long-term effects on humans and the environment. This research aims to quantify particulate matter's severe impact on inhabitants and identify the ecological environment risk category of Kota city, Rajasthan (India), throughout the selected study period from 2018 to 2022 for four years. Human health risk assessment has been assessed through AirQ+ software (WHO invented), while ecological hazard risk categories were recognised through risk quotient (RQ). The present scenario of particulate matter concentration is compared with standards given by different regulating agencies (WHO, USEPA, and Indian NAAQS) to verify particulate matter pollution. The current particulate matter concentration levels of Kota city are also compared with different regional cities of Rajasthan (India), namely, Jaipur, Udaipur, Ajmer, Pali, Alwar, and Jodhpur. The dust ratio (PM2.5/PM10) is computed for Kota and regional cities to validate the increasing levels of fine particulates than the larger ones. The four-year average concentration of PM10 and PM2.5 were 121 and 58 µg/m3, respectively, with a dust ratio of 0.48. Particulate matter concentrations (PM10 and PM2.5) are violating the standards set by environmental agencies during the study period. The mean risk quotient (RQ) is 2.02 for PM10 and 1.43 for PM2.5, which implies a high-risk hazard category (RQ > 1) in the ecological environment of Kota city. The mortality cases evaluated from AirQ+ software were 5024 for all natural causes, 885 for lung cancer, 272 for acute lower respiratory infection, 464 for COPD, 2060 for IHD, and 1880 for stroke. The number of hospital admissions was 1485 for respiratory disease, 58 for cardiovascular disease, and 784 for adult mortality (30+ years) to PM2.5. Chronic bronchitis incidence in adults was 14469, postneonatal infant mortality was 355816, and the prevalence of bronchitis in children was 767 due to PM10 exposure for a long time, while asthma symptoms in asthmatic children were 349 due to exposure for a short time. The results of this study are terrifying, and it is an earlier sign to government representatives and stakeholders to implement the new policies and technologies to curb the pollution level originating from particulate matter; otherwise, impacts on the environment become more acute.

Air Quality Assessment with Human Health Effects for Kota Metropolis, Rajasthan India.

Bad air quality is the number one environmental concern globally due to its severe impact on animals, plant life, humans and property. This study has assessed air quality and health impact on humans in Kota metropolis, Rajasthan (India), to increase the understanding of the relation between health and pollutant sources, emission characteristics, topography, and meteorological conditions. AQI and EF are also calculated to determine the pollution category and critical level of pollutants, respectively. The health effects of particulate matter on inhabitants are estimated with the AirQ+ software. The annual concentration of PM10 and PM2.5 were more than prescribed limits by CPCB, while SO2 and NO2 are well below the prescribed limits. The maximum concentrations of pollutants were detected in Winter, followed by Summer and Rainy seasons. AQI varies from satisfactory to inferior category. EF was more than 1 for all monitoring stations for PM10 and PM2.5 exhibiting High pollution, 0.5-.09 indicates Moderate pollution for NO2, while less than .5 for SO2 shows Low pollution. Particulate matter is the primary cause of air pollution. The PM2.5 induced ENACs (Estimated Number of Attributable Cases) for all causes of mortality, COPD, ALRI, LC, IHD, and stroke were 4546, 435, 255, 806,1958, and 1772, respectively. The ENACs for post neonatal infant mortality, the prevalence of bronchitis, and chronic bronchitis due to PM10 increased by 326006, 716, and 13700, respectively. This study carries useful findings and suggestions for stakeholders and policymakers to control and mitigate the decrement in air quality.

O22 - Reducing Infant Mortality in Queensland: the impact of the Pēpi-Pod® Program

The Queensland Pēpi-Pod® Program was introduced as a staged research intervention in partnership with Aboriginal and Torres Strait Islander communities, and Change for our Children, New Zealand in 2012-2018 to determine cultural, community and individual acceptability, safety and feasibility. This three-part program (sleep space, safe care, family as safe sleep influencers) addressed the vulnerability of infants in unsafe sleep environments that increase suffocation risk. ‘If it’s safe to breathe, it’s safe to sleep’ was the underlying gist message promoted. While successfully implemented, and with some communities continuing to engage in the program post-research, the initial study was not designed to measure mortality benefit. The aim of this study was to determine if the Pēpi-Pod® Program implementation was temporally associated with a reduction in infant mortality in Queensland. Using research participant data (n=617) and linked Queensland population data, research locations were stratified into three subgroups based on participation rate within each geographic location and participant Indigeneity as a proportion of the location’s Indigenous population. Infant Mortality Rate (IMR) was the outcome, defined as all-cause post-neonatal infant mortality between one and six months of age. Outcomes within and between research location subgroups, and whole of Queensland Study IMR before and after the research intervention were compared. After the Pēpi-Pod® Program intervention study IMR fell in two of the three research location subgroups. The greatest fall occurred in the subgroup with the highest rate of participation and participant Indigeneity (Rate Ratio 0.25, {95% Confidence Intervals 0.06,1.08}, P=0.08). The whole of Queensland Study IMR decreased significantly after the intervention (RR 0.78 {95%CI 0.65,0.92}, P=0.004). The Pēpi-Pod® Program was hypothesised to be responsible for this reduction in Study IMR. This Program presents a practical and tangible strategy to reduce infant mortality experienced by priority populations.

Particulate Matter Associated Human Health Effects Determination Through AirQ+ for Alwar, Rajasthan (India)

The present study estimates the long-term and short-term health impacts of particulate matter on humans in Alwar, Rajasthan (India), with the help of AirQ+ software. The annual concentration of particulate matter violates the Indian and WHO standards. The PM2.5 induced long-term estimated number of attributable cases (ENACs) for mortality due to all-natural causes in adults, LC, ALRI, COPD, IHD, and stroke were 12867, 2225, 634, 1089, 4671, and 4353, respectively, while short-term ENACs for hospital admission due to respiratory disease, cardiovascular disease, and all-cause mortality in adults were 4399, 174, and 2333, respectively. The PM10 induced long-term ENACs for post-neonatal infant mortality, chronic bronchitis in adults, and the prevalence of bronchitis in children were 878494, 32698, and 700, respectively, while short-term ENACs for incidence of asthma symptoms in asthmatic children were 1799. The estimated human health risk assessment results are terrifying and require immediate actions from policymakers for mitigation.

A Case Study on Human Health Risk Assessment Attributable to Particulate Matter at Kota Metropolis, Rajasthan (India)

Kota, an Indian metropolis, has been experiencing high particulate matter pollution for the last few years. The primary aim of this study is to perform a human health risk assessment caused by particulate matter concentrations for Kota Metropolis. The annual PM2.5 and PM10 concentrations for Kota Metropolis were 52.63 and 106.86 µg/m3, respectively, indicating the violation of Indian NAAQS. The PM2.5 induced long-term ENACs for mortality due to all-natural causes in adults, LC, ALRI, COPD, IHD, and Stroke were 4624, 819, 258, 440, 1976, and 1791, respectively, while short-term ENACs for hospital admission due to respiratory disease, cardiovascular disease, and all-cause mortality in adults were 1288, 50, and 679, respectively. The PM10 induced long-term ENACs for postneonatal infant mortality, chronic bronchitis incidences (adults), and pervasiveness of bronchitis in kids were 317131, 13448, and 700, respectively. The study presents important conclusions to stakeholders and policymakers to implement suitable mitigation measures.

Risk of Postneonatal Infant Mortality Associated With Prior Founded Allegations of Child Abuse

This study examined the association between prior reports of child abuse and subsequent postneonatal death and differences by cause of death, using data from the Chicago Infant Mortality Study (CIMS). CIMS included all sudden, unexplained infant deaths up to 1year of age in Chicago (November 1993-April 1996), and age, race-ethnicity, and birthweight-matched living controls. Information on prior child abuse reports and outcomes was obtained through the Illinois Department of Children and Family Services (DCFS) State Central Registry for each case and control. Conditional logistic regression modeling determined the odds of postneonatal death when there was a founded prior allegation. Families with founded allegations were almost 4 times more likely to have a child die during the postneonatal period (aOR = 3.79, 95% CI, 1.56, 9.10). Child protective services involvement is an opportunity for education on safe sleep messaging to help reduce the incidence of potentially preventable infant deaths.

Assessment of sources and health impacts of PM10 in an urban environment over eastern coastal plain of India

Aerosol health impacts are gaining considerable attention from the scientific community. Our study's primary purpose was to identify the source regions of PM10 and quantify its long-term health effects at an eastern Indian urban site Bhubaneswar from July 2018 to June 2019. The seasonal average of PM10 surface observations displayed higher values in winter, followed by post-monsoon, summer and monsoon. Eastern India, Northern India, and South-East Asia emerged as potential source regions of PM10 contributors to the study location using source-receptor models. The health endpoints, (i) incidence of chronic bronchitis in adults, (ii) post neonatal infant mortality and, (iii) prevalence of bronchitis in children, were estimated employing the World Health Organization developed model, AirQ+. The attributable proportion, the excess number of attributable cases, and the excess number of attributable cases per 100,000 population for three endpoints showed the highest impact during the winter season. Winter impact is 3 to 5 times higher compared to the rest of other seasons. This study highlights the health impact of PM10 on the population of Bhubaneswar, especially during winter. Thus, it is imperative to give considerable focus to controlling and mitigating air pollution at the investigation location.

Impact of newly constructed primary healthcare centres on antenatal care attendance, facility delivery and all-cause mortality: quasi-experimental evidence from Taabo health and demographic surveillance system, Côte d’Ivoire

ObjectivesAccess to quality care remains limited, particularly in low-income and middle-income countries. Although better health outcomes for families living in close proximity to healthcare facilities have been documented in cross-sectional...

Social determinants of health affect post-neonatal infant mortality: a case control field study.

The Anatolian Journal of Family Medicine is an international periodical on family medicine and primary health care, published three times a year on independent, unbiased, double-blinded and peer-review principles.

Prevalence, risk factors and short-term consequences of adverse birth outcomes in Zimbabwean pregnant women: a secondary analysis of a cluster-randomized trial.

Globally, 15 million children are born preterm each year and 10.7 million are born at term but with low birthweight (<2500 g). The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) cluster-randomized trial enrolled 5280 pregnant women between 22 November 2012 and27 March 2015 to test the impact of improved water supply, sanitation and hygiene, and improved infant feeding, on child growth and anaemia. We conducted a secondary analysis to estimate the prevalence and risk factors of miscarriage, stillbirth, preterm birth, size small for gestational age (SGA), low birthweight (LBW), perinatal mortality, and neonatal mortality, and to estimate the effects of adverse birth outcomes on infant survival and growth. The prevalence of adverse birth outcomes was: miscarriage: 5.0%[95% confidence interval (CI), 4.4, 5.7]; stillbirth:2.3% (95% CI 1.9, 2.7);preterm birth: 18.2% (95% CI 16.9, 19.5); SGA: 16.1% (95% CI 15.0, 17.3); LBW: 9.8% (95% CI 9.0, 10.7); andneonatal mortality:31.4/1000 live births (95% CI 26.7, 36.5). Modifiable risk factors included maternal HIV infection, anaemia, lack of antenatal care and non-institutional delivery. Preterm infants had higher neonatal mortality [risk ratio (RR): 6.1 (95% CI 4.0, 9.2)], post-neonatal infant mortality [hazard ratio (HR): 2.1 (95% CI 1.1, 4.1)] and stunting at 18 months of age [RR: 1.5 (95% CI 1.4, 1.7)] than term infants; 56% of stillbirths and 57% of neonatal deaths were among preterm births. Neonatal mortality and stillbirth are high in Zimbabwe and appear to be driven by high preterm birth. Interventions for primary prevention of preterm birth and strengthenedmanagement of preterm labour and ill and small neonates are required to reduce neonatal mortality in Zimbabwe and other African countries with similar profiles.

The effects of meteorological parameters on PM10: Health impacts assessment using AirQ+ model and prediction by an artificial neural network (ANN)

The estimation of PM10 health effects and air quality forecasting plays an essential role in protecting public health against harmful air pollutants. This study aimed to estimate the impact of meteorological parameters on PM10, evaluate its health impacts, and its prediction using an artificial neural network (ANN) in Yasuj. Demographic, meteorological, and PM10 data were collected from March 2013 to March 2018 in one of Iran's cities. The health impacts of PM10 were estimated using the AirQ+ software. Furthermore, the daily average of PM10 concentrations combined with the meteorological data was used to predict PM10 concentration. The results showed a greater risk of respiratory symptoms for the incidence of asthma symptoms in asthmatic children, the prevalence of bronchitis in children, incidence of chronic bronchitis in adults, and postneonatal infant mortality due to exposure to PM10 with a relative risk of 1.028, 1.08, 1.117, and 1.04 respectively. Also, the best MLP-ANN model predicted PM10 value with correlation coefficient (R2) of 0.87. It can be concluded that decreased PM10 levels were associated with reduced symptoms of bronchitis and asthma in children and bronchitis in adults, and ANN modeling provides a feasible procedure for managerial planning in the view of air pollution.

Nicotinic Receptors in the Brainstem Ascending Arousal System in SIDS With Analysis of Pre-natal Exposures to Maternal Smoking and Alcohol in High-Risk Populations of the Safe Passage Study.

Pre-natal exposures to nicotine and alcohol are known risk factors for sudden infant death syndrome (SIDS), the leading cause of post-neonatal infant mortality. Here, we present data on nicotinic receptor binding, as determined by 125I-epibatidine receptor autoradiography, in the brainstems of infants dying of SIDS and of other known causes of death collected from the Safe Passage Study, a prospective, multicenter study with clinical sites in Cape Town, South Africa and 5 United States sites, including 2 American Indian Reservations. We examined 15 pons and medulla regions related to cardiovascular control and arousal in infants dying of SIDS (n = 12) and infants dying from known causes (n = 20, 10 pre-discharge from time of birth, 10 post-discharge). Overall, there was a developmental decrease in 125I-epibatidine binding with increasing postconceptional age in 5 medullary sites [raphe obscurus, gigantocellularis, paragigantocellularis, centralis, and dorsal accessory olive (p = 0.0002–0.03)], three of which are nuclei containing serotonin cells. Comparing SIDS with post-discharge known cause of death (post-KCOD) controls, we found significant decreased binding in SIDS in the nucleus pontis oralis (p = 0.02), a critical component of the cholinergic ascending arousal system of the rostral pons (post-KCOD, 12.1 ± 0.9 fmol/mg and SIDS, 9.1 ± 0.78 fmol/mg). In addition, we found an effect of maternal smoking in SIDS (n = 11) combined with post-KCOD controls (n = 8) on the raphe obscurus (p = 0.01), gigantocellularis (p = 0.02), and the paragigantocellularis (p = 0.002), three medullary sites found in this study to have decreased binding with age and found in previous studies to have abnormal indices of serotonin neurotransmission in SIDS infants. At these sites, 125I-epibatidine binding increased with increasing cigarettes per week. We found no effect of maternal drinking on 125I-epibatidine binding at any site measured. Taken together, these data support changes in nicotinic receptor binding related to development, cause of death, and exposure to maternal cigarette smoking. These data present new evidence in a prospective study supporting the roles of developmental factors, as well as adverse exposure on nicotinic receptors, in serotonergic nuclei of the rostral medulla—a finding that highlights the interwoven and complex relationship between acetylcholine (via nicotinic receptors) and serotonergic neurotransmission in the medulla.

Long-term trend of ambient air PM10, PM2.5, and O3 and their health effects in Tabriz city, Iran, during 2006–2017

This study was conducted to investigate the long-term temporal trends and spatial variations of ambient PM10, PM2.5 and O3 concentrations using the Moran’s I index and Mann-Kendall's test and also to evaluate their health effects in Tabriz city, between 2006 and 2017. The health impacts of air pollutants were estimated using the World Health Organization (WHO) AirQ + software updated in 2017. The results showed that the annual trend of PM concentrations was decreasing while O3 concentration was almost constant during the study period. The results indicated that in approximately 59 % and 4 % of the studied days for PM10, 48 % and 28 % for PM2.5, and 3 % and 0.3 % for O3, inhabitants of Tabriz city were exposed to the air pollutants in levels greater than the WHO AQG and National and U.S.EPA standard levels. Moreover, the highest monthly mean concentrations of PM10, PM2.5, and O3 were respectively observed in May (80.4 μg/m3), December (42.5 μg/m3), and June (78.4 μg/m3).It was estimated that attributable proportions due to long-term exposure to PM10 were between 7.9 % and 28.7 % for post neonatal infant mortality and between 20.7 % and 61.5 % for incidence of chronic bronchitis in adults. Long-term exposure to PM2.5 was attributed to about 11.8 % from all-cause, 34.6 % from ischemic heart disease, 26.7 % from stroke, 23.4 % from chronic obstructive pulmonary disease, 24.2 % from acute lower respiratory infection, and 16.5 % from lung cancer mortalities.Our study results showed that there were no effective policies and strategies to reduce Tabriz air pollution during the study period; and codification and implementation of effective control policies is necessary to improve ambient air quality of Tabriz.

Variation in relationships between maternal age at first birth and pregnancy outcomes by maternal race: a population-based cohort study in the United States

ObjectiveTo estimate absolute risks of obstetric outcomes in the USA according to maternal age at first birth from age 15 to 45 separately by maternal race.Design and settingPopulation-based cohort study.SettingVital...