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Berky AJ, Weinhouse C, Vissoci J, Rivera N, Ortiz EJ, Navio S, Miranda JJ, Mallipudi A, Fixen E, Hsu-Kim H, Pan WK. In Utero Exposure to Metals and Birth Outcomes in an Artisanal and Small-Scale Gold Mining Birth Cohort in Madre de Dios, Peru. Environ Health Perspect 2023; 131:97008. [PMID: 37747404 PMCID: PMC10519195 DOI: 10.1289/ehp10557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Few birth cohorts in South America evaluate the joint effect of minerals and toxic metals on neonatal health. In Madre de Dios, Peru, mercury exposure is prevalent owing to artisanal gold mining, yet its effect on neonatal health is unknown. OBJECTIVES We aimed to determine whether toxic metals are associated with lower birth weight and shorter gestational age independently of antenatal care and other maternal well-being factors. METHODS Data are from the COhorte de NAcimiento de MAdre de Dios (CONAMAD) birth cohort, which enrolled pregnant women in Madre de Dios prior to their third trimester and obtained maternal and cord blood samples at birth. We use structural equation models (SEMs) to construct latent variables for the maternal metals environment (ME) and the fetal environment (FE) using concentrations of calcium, iron, selenium, zinc, magnesium, mercury, lead, and arsenic measured in maternal and cord blood, respectively. We then assessed the relationship between the latent variables ME and FE, toxic metals, prenatal visits, hypertension, and their effect on gestational age and birth weight. RESULTS Among 198 mothers successfully enrolled and followed at birth, 29% had blood mercury levels that exceeded the U.S. Centers for Disease Control and Prevention threshold of 5.8 μ g / L and 2 mothers surpassed the former 5 - μ g / dL threshold for blood lead. The current threshold value is 3.5 μ g / dL . Minerals and toxic metals loaded onto ME and FE latent variables. ME was associated with FE (β = 0.24; 95% CI: 0.05, 0.45). FE was associated with longer gestational age (β = 2.31; 95% CI: - 0.3 , 4.51) and heavier birth weight. Mercury exposure was not directly associated with health outcomes. A 1% increase in maternal blood lead shortened gestational age by 0.05 d (β = - 0.75 ; 95% CI: - 1.51 , - 0.13 ), which at the 5 - μ g / dL threshold resulted in a loss of 3.6 gestational days and 76.5 g in birth weight for newborns. Prenatal care visits were associated with improved birth outcomes, with a doubling of visits from 6 to 12 associated with 5.5 more gestational days (95% CI: 1.6, 9.4) and 319 g of birth weight (95% CI: 287.6, 350.7). DISCUSSION Maternal lead, even at low exposures, was associated with shorter gestation and lower birth weight. Studies that focus only on harmful exposures or nutrition may mischaracterize the dynamic maternal ME and FE. SEMs provide a framework to evaluate these complex relationships during pregnancy and reduce overcontrolling that can occur with linear regression. https://doi.org/10.1289/EHP10557.
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Affiliation(s)
- Axel J Berky
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
| | - Caren Weinhouse
- Oregon Institute of Occupational Health Sciences, Oregon Health & Sciences University, Portland, Oregon, USA
| | - Joao Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nelson Rivera
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - Ernesto J Ortiz
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Susy Navio
- Dirección Regional de Salud, Ministerio de Salud del Perú, Madre de Dios, Perú
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andres Mallipudi
- Bellevue Hospital Center/Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Emma Fixen
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Heileen Hsu-Kim
- Department of Civil and Environmental Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina, USA
| | - William K Pan
- Nicholas School of the Environment, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Isaacson J, Joiner A, Kozhumam A, Caruzzo N, Andrade L, Iora P, Costa D, Vissoci B, Sartori M, Rocha T, Vissoci J. 91 Access to Care for Emergency Care-Sensitive Conditions in Brazil: A Geographic Information System Approach. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Fiorino C, Phillips A, Limkakeng A, Staton C. 94EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8536271 DOI: 10.1016/j.annemergmed.2021.09.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Purakal J, Seidenfeld J, Tupetz A, Vissoci J, Silva L, Limkakeng A, Fiorino C, Phillips A, Staton C. 30EMF COVID-19 Infection Experiences and Social Determinants of Health in North Carolina: A Qualitative Analysis. Ann Emerg Med 2021. [PMCID: PMC8335433 DOI: 10.1016/j.annemergmed.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Purakal J, Silva L, Tupetz A, Seidenfeld J, Limkakeng A, Staton C, Vissoci J. 27EMF Social Determinants of Health and COVID-19 Infection in North Carolina: A Geospatial Analysis. Ann Emerg Med 2021. [PMCID: PMC8335497 DOI: 10.1016/j.annemergmed.2021.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elahi C, Adil SM, Vissoci J, Staton C, Fuller A, Haglund MM, Dunn T. A Decision Curve Analysis to Compare Multiple TBI Models and Estimate Their Clinical Impact. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Farrow NE, Jane Commander S, Reed CR, Mueller J, Vissoci J, Sekabira J, Fitzgerald TN. Laparoscopic Experience and Attitudes Toward a Low-Cost Laparoscopic System among Surgeons in East, Central, and Southern Africa. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
OBJECTIVES The optimal size of the health workforce for children's surgical care around the world remains poorly defined. The goal of this study was to characterise the surgical workforce for children across Brazil, and to identify associations between the surgical workforce and measures of childhood health. DESIGN This study is an ecological, cross-sectional analysis using data from the Brazil public health system (Sistema Único de Saúde). SETTINGS AND PARTICIPANTS We collected data on the surgical workforce (paediatric surgeons, general surgeons, anaesthesiologists and nursing staff), perioperative mortality rate (POMR) and under-5 mortality rate (U5MR) across Brazil for 2015. PRIMARY AND SECONDARY OUTCOME MEASURES We performed descriptive analyses, and identified associations between the workforce and U5MR using geospatial analysis (Getis-Ord-Gi analysis, spatial cluster analysis and linear regression models). FINDINGS There were 39 926 general surgeons, 856 paediatric surgeons, 13 243 anaesthesiologists and 103 793 nurses across Brazil in 2015. The U5MR ranged from 11 to 26 deaths/1000 live births and the POMR ranged from 0.11-0.17 deaths/100 000 children across the country. The surgical workforce is inequitably distributed across the country, with the wealthier South and Southeast regions having a higher workforce density as well as lower U5MR than the poorer North and Northeast regions. Using linear regression, we found an inverse relationship between the surgical workforce density and U5MR. An U5MR of 15 deaths/1000 births across Brazil is associated with a workforce level of 5 paediatric surgeons, 200 surgeons, 100 anaesthesiologists or 700 nurses/100 000 children. CONCLUSIONS We found wide disparities in the surgical workforce and childhood mortality across Brazil, with both directly related to socioeconomic status. Areas of increased surgical workforce are associated with lower U5MR. Strategic investment in the surgical workforce may be required to attain optimal health outcomes for children in Brazil, particularly in rural regions.
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Affiliation(s)
| | - Joao Vissoci
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Nubia Rocha
- Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Dan Poenaru
- Pediatric Surgery, Montreal Children\'s Hospital Research Institute, Montreal, Quebec, Canada
| | - Mark Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otology and Laryngology and Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Emily R Smith
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
- Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Henry E Rice
- Duke University Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Abdelgadir J, Smith E, Punchak M, Vissoci J, Staton C, Park L, Muhindo A, Kitya D, Haglund M. Outcomes and Predictors of Mortality in Neurosurgery Patients at Mbarara
Regional Referral Hospital, Mbarara, Uganda. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nwosu C, Batakana S, Vissoci J, Vaca S, Lim S, Smith E, Fuller A, Haglund M. Identifying the Needs and Barriers to Patient-Family Education to Design
Educational Interventions that will Improve Neurosurgery Patient Outcomes in
Mulago Hospital, Uganda. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zick B, Abdelgadir J, Muhindo A, Muhumuza C, Smith E, Vissoci J, Haglund M. Methodological Comparisons in Assessing Neurosurgical Capacity in
Uganda. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Nguyen TDV, Joelson T, Vissoci J, Pesambili M, Haglund M, Mvungi M, Staton CA. 519 Injury prevalence and safety habits of motorcycle taxi drivers in urban Moshi, Tanzania. Inj Prev 2016. [DOI: 10.1136/injuryprev-2016-042156.519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Abdelgadir J, Zhao Y, Liu C, Pei F, Zick B, Ratliff CD, Rotich C, Jadue N, de Andrade L, von Isenburg M, Hocker M. Correction: Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PLoS One 2016; 11:e0150150. [PMID: 26894996 PMCID: PMC4760678 DOI: 10.1371/journal.pone.0150150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Abdelgadir J, Zhou Y, Liu C, Pei F, Zick B, Ratliff CD, Rotich C, Jadue N, de Andrade L, von Isenburg M, Hocker M. Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PLoS One 2016; 11:e0144971. [PMID: 26735918 PMCID: PMC4703343 DOI: 10.1371/journal.pone.0144971] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.
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Affiliation(s)
- Catherine Staton
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Joao Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Enying Gong
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rebeccah Wafula
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jihad Abdelgadir
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yi Zhou
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Chen Liu
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Fengdi Pei
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Brittany Zick
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Camille D. Ratliff
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Claire Rotich
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Jadue
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Megan von Isenburg
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Michael Hocker
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
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