A Dissertation Submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg for the degree of Master of Medicine. / Disturbed mineral and bone metabolism is frequently found in very low-birth-weight infants fed breast-milk during the first three months of life. The study was designed to assess the prevalence of this disturbed mineral homeostasis in a very low-birth-weight populatiun at Baragwanath Hospital and to determine whether the addition of a preterm infant formula to the feeds reduced the prevalence and increased the rate of weight gain. Fifty three neonates weighing less than 1200g born at Baragwanath Hospital were monitored for weight gain, growth and for biochemical and radiological evidence of metabolic bone disease. The infants were randomized to receive either breast-milk only feeds or a combination of breast-milk and a premature formula in order to assess the effect of the different feeds on the development of bone disease. Weight gain and growth were similar in both groups. Calcium and phosphorus intakes were higher in the mixed feeding group. However, serum calcium and phosphorus values were similar in the two groups throughout the study. The breast-milk group had significantly higher alkaline phosphatase levels. Radiological rickets was uncommun in both groups, although periosteal reactions and osteopenia occurred frequently and with similar prevalence in both groups. Overt rickets is not a major problem in very-low birth- weight infants born at Baragwanath Hospital, although raised serum alkaline phosphatase values occur frequently. Feeding with breast-milk and a premature infant formula in equal proportions (as opposed to breast-milk only) does not appear to have any effect on weight gain and growth in very low-birth-weight infants, but does partially prevent the pathological rise in alkaline phosphatase levels. / Andrew Chakane 2019

Background: Limited epidemiologic studies have investigated the effects of pesticide exposure during pregnancy on low birth weight in offspring in rural China.Methods: A survey of a total of 503 women was conducted in Ling county of Shandong Province of China following delivery from 1 November 2009 to 8 February 2010.Results: After adjustment for confounding and compared with no pesticide exposure, multiple logistic regression showed a non-significant increased likelihood of low birth weight for both children of mothers exposed to pesticides when not pregnant (OR = 1.80, 95% CI: 0.62, 5.22) and mothers exposed to pesticides during pregnancy (OR = 2.42, 95% CI: 0.73, 8.08); multiple linear regression showed a non-significant reduced birth weight for both children of mothers exposed to pesticides when not pregnant (β=–0.59, p=0.28) and mothers exposed to pesticides during pregnancy (β=–0.89, p=0.15).Conclusions: Exposure to pesticides during pregnancy was associated with a non-significant increase in low birth weight in this rural Chinese population. Future studies using larger sample sizes and longer follow-up periods are warranted.

Thesis (PhD. (Clinical Psychology)) --University of Limpopo, 2008 / Low-birth-weight/premature children seem to be vulnerable to psychiatric, neuropsychological and other deficiencies. Limited research is available in the South African context about these ever-increasing phenomena. The aim of this study was to investigate the magnitude and characteristics of internalising (Separation Anxiety, Overanxious and Major Depressive Disorders) and externalising symptoms (Attention-Deficit/Hyperactivity, Oppositional Defiant and Conduct Disorders) among low-birth-weight children in comparison with normal-birth-weight children, as well as to establish neuropsychological deficiencies (motor, visual-spatial, memory and executive functioning) between the birth weight groups, analysed as a function of gender and age. The sample (158 children) was selected from nine urban mainstream primary schools in the Tshwane North and South districts by means of stratified random sampling. Low-birth-weight children (weighing below 2 000 g) (N=79) were matched with normal-birth-weight children (above 3 000 g) (N=79) according to age, gender, language and socio-economic status. The neuropsychological test battery and self-reporting questionnaire were individually administered to the sample at the selected schools during school hours. Teachers and parents of selected participants were requested to complete a rating scale. As expected, low birth weight is associated with a tendency towards increased internalising and externalising psychological symptoms, as well as poorer neuropsychological functioning. This was particularly significant in the domains of internalising symptoms (depression), externalising symptoms (hyperactivity/impulsiveness, inattention, Oppositional Defiant Disorder and Conduct Disorder) and neuropsychological impairments (motor, visual-spatial/visual-motor, memory and executive functioning). The neuropsychological impairments observed in this study among the LBW children probably increase the risk of subsequent externalising (conduct and oppositional behavioural problems) and internalising (depressive) psychological symptoms. These impairments are possibly exacerbated by inattention and hyperactivity/ impulsiveness. Reciprocal interaction seems to take place between the psychological symptoms andneuropsychological functions. Only a few gender differences were observed. Neuropsychological deficits were observed both in the 6 to 9 and 10 to 13 age groups, indicating deficient resolution of impairments with increasing age. Increased pre-, peri- and postnatal complications in the low-birth-weight group may predispose these children biologically to neuropsychological deficiencies and subsequent internalising/externalising symptoms. These impairments most probably affect academic, emotional, social and other significant areas of functioning, increasing public health cost.

<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

Background and aim: Persons sustaining different types of brain injury may experience difficulties with advanced mobility. Both persons with traumatic brain injury (TBI) and persons born with very low birth weight (VLBW) have similar brain abnormalities, such as reduced white matter and connectivity, and may thus experience similar mobility problems. However, few studies have assessed advanced motor abilities, and none have compared mobility functions in adult TBI and VLBW populations. Our aim was to investigate high level mobility functions in adults with TBI and VLBW adults compared to matched controls, and to compare high-level mobility in TBI and VLBW adults. Methods: Participants consisted of 22 subjects (mean age 22.9 ± 2.0 yrs) with chronic traumatic brain injury, and 35 subjects (mean age 22.5 ± 0.7 yrs) born preterm with birth weight (below 1500 grams). Two TBI participants were not able to complete all test items due to pain. The VLBW group included three subjects with cerebral palsy (CP). Each group was matched with its own control group, consisting of 24 subjects each from the same geographical area matched by age and sex. Mean age in the control group was 23.3 ± 1.8 yrs for TBI and 22.8 ± 0.5 yrs for VLBW. Advanced mobility functions were assessed by the High-level Mobility Assessment Tool (HiMAT), which consists of 13 timed mobility tasks, with a maximum total HiMAT score of 54. Results: Mean total HiMAT score in the TBI group was 47.0 ± 7.7 compared to 50.3 ± 3.9 for the controls (U=193, p=0.116). Three of 13 mobility tasks differed significantly from the control group: ‘walking’, ‘walk over obstacle’ and ‘bound non-affected leg’. When the two subjects who reported pain were excluded from the analysis, mean total HiMAT score was 48.9 ± 4.9 (U=193, p=0.264), with ‘walking’ and ‘walk over obstacle’ remaining significantly different from the control group. In the TBI group, nine (40.9%) participants performed at or below the 5th percentile compared to 6 (25%) of the TBI controls. Mean total HiMAT score in the VLBW group was 45.1 ± 7.8 compared to 49.9 ± 3.5 in its control group (U = 256, p=0.011). Five of the 13 mobility task scores were significantly different from the control group: ‘walking backwards’, ‘running’, ‘hop affected leg’, ‘bound affected leg’, and ‘bound non-affected leg’. When the three subjects with CP were excluded, mean total HiMAT score was 46.8 ± 5.5 in the VLBW group (U=256, p=0.033) and three mobility task scores remained significantly different from the controls: ‘walking backwards’, ‘hop affected leg’ and ‘bound non-affected leg’. In the VLBW group, 17 (48.6%) participants performed at or below the 5th percentile compared to 4 (16.7%) of the VLBW controls. When directly compared to the VLBW group, the TBI group had (OR 0.733, CI 0.249 – 2.154) lower risk for performing at or below the 5th percentile, although not significant. Conclusions: Compared to controls, adults with TBI had reduced high-level mobility in specific tasks. Adults born with VLBW had reduced overall high level mobility. Furthermore, the HiMAT seems to be a valuable tool for assessing high-level mobility in VLBW populations, and should be formally tested for further use. Keywords: High-level mobility, high-level mobility assessment tool, traumatic brain injury, very low birth weight

<p>Background: Childrens health, particularly in the early years, forms the basis of future health and development and plays a significant role in predicting individual life and opportunities. Thus, studies which enhance the understanding of the determinants of childrens health status are needed. Previous research on childrens health had focused on the familys and infants characteristics and ignored the potential impact of macro-level influences. The objectives of this thesis were (i) to examine the independent effects of neighbourhood factors on childhood health outcomes, (ii) to explore neighbourhood moderating effects on the associations between some individual risk factors and childhood health outcomes, and (iii) to quantify the contribution of neighbourhood factors to childhood health outcomes.</p><p>Method: The study population included 9,888 children born to women residing in Saskatoon during three years, 1992-1994. The data used in this study were extracted from three sources. The information related to birth outcomes and the mothers characteristics was extracted from the birth registration files maintained by Saskatchewans Vital Statistics Branch. The health services utilization information was generated from Saskatchewan Healths computerized administrative databases. The information related to the neighbourhood characteristics was obtained from Statistics Canadas 1991 Census, from local sources such as the Planning Department of the City, and two specialized neighbourhood surveys. Six domains of neighbourhood were examined in this study: socio-economic disadvantage, social interaction, physical condition, population density, local programs and services, and unhealthy lifestyle norm. This study was divided into two focused topics corresponding to two childrens health outcomes: low birth weight (LBW) and childrens hospitalizations (both incidence and length of stay). Multilevel modelling was employed to examine the independent/moderating impacts of neighbourhood characteristics on these childrens health outcomes. GIS mapping was used to visualize the associations between neighbourhood characteristics and childrens health outcomes.</p><p>Findings of focused topic 1: There was a significant variation across Saskatoon neighbourhoods in the distribution of LBW rate. This significant variation was attributed to both the characteristics of individuals living within the neighbourhoods as well as the characteristics of the neighbourhood of residence. Neighbourhood variables were both independent risk factors for LBW and moderators for the association between maternal characteristics and LBW. Specifically, a greater level of socio-economic disadvantage, a lower level of program availability and accessibility within the neighbourhoods were associated with a higher risk of LBW. A significant interaction between neighbourhood social interaction and single parent status was found. The risk of single parent status on LBW was mitigated by a greater level of social interaction within neighbourhoods. With individual level variables held constant, three neighbourhood variables predicted LBW, together contributing to a change in LBW rate of 7.0%.</p><p>Findings of focused topic 2: This focused topic employed a longitudinal/multilevel design to examine the effects of socio-economic status at multiple levels on childrens hospitalization. The key findings of this focused topic are the following: (i) There was a gradient association between the number of adverse birth outcomes and childhood hospitalization; (ii) There was a significant interaction between family income and adverse birth outcomes (i.e., the effect of adverse birth outcomes on childhood hospitalization was heightened among those children living in low income families); (iii) Neighbourhood characteristics, specifically neighbourhood socio-economic disadvantage, neighbourhood physical condition, and neighbourhood population density had independent effects on childhood hospitalization over and above the effect of family income; (iv) With individual level variables held constant, three neighbourhood variables (i.e., neighbourhood socio-economic disadvantage, physical condition and population density) together accounted for a variation of 40% in the incidence rate of hospitalization, and two neighbourhood variables (i.e., neighbourhood socio-economic disadvantage and physical condition) together accounted for a change in the length of stay per hospitalization from 2.88 days to 5.18 days across neighbourhoods.</p><p>Conclusion: Both individual and neighbourhood characteristics determined childhood health outcomes examined. Neighbourhood factors acted as independent risk factors as well as moderators on the association between individual risk factors and health outcomes. The contribution of neighbourhood factors to childrens health outcomes was quite substantial. The findings suggest that future interventions aimed at improving childrens health status in Saskatoon may be enhanced by targeting both high risk individuals and high risk neighbourhoods. The geographical variations in childrens health outcomes reported in this study are modifiable; they can be altered through public policy and urban planning, and through the efforts of families and children.

No description available.

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 70-78).

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.