Maternal body mass index, smoking status and small for gestational age: an Australian retrospective cohort study.

OBJECTIVES: Both maternal body mass index (BMI) and smoking during pregnancy have been associated with a range of adverse maternal and infant birth outcomes. This study aimed to identify whether these independent variables had an interacting relationship with small for gestational age in an Australian obstetric cohort. STUDY DESIGN: A retrospective cohort design used data from the Birthing Outcomes System of a major tertiary hospital in Australia. METHODS: A total of 14,487 singleton births between January 2008 and December 2013 were included in the analysis. Chi-squared tests and one-way analysis of variance were used for the comparison of categorical and continuous variables, respectively. Adjusted odds ratios (AORs) were calculated to determine the association of smoking status with the outcome variable of interest, and these are reported for each maternal BMI category. RESULTS: Of the 14,487 women, 716 (4.9%) were underweight (BMI ≤18 kg/m2), 7268 (50.2%) had healthy weight (BMI = 19-24 kg/m2), 3658 (25.3%) were overweight (BMI = 25-29 kg/m2), 1558 (10.8%) had class I obesity (BMI = 30-34 kg/m2), 711 (4.9%) had class II obesity (BMI = 35-39 kg/m2) and 576 (3.9%) had class III obesity (BMI = 40+ kg/m2). Of all women, 10.8% reported being current smokers, 82.0% reported to have never smoked and 4.0% reported to have stopped smoking during or before pregnancy. Smokers with a BMI ≥40 kg/m2 were 4.5 (AOR = 4.508; 95% confidence interval: 2.068-9.828) times more likely to give birth to a small-for-gestational-age infant than non-smokers within the same BMI category. This increased risk was not observed in women who ceased smoking before or during pregnancy. CONCLUSIONS: Our study supports the efficacy of antismoking policies within maternal public health. In addition, greater support with respect to smoking cessation is indicated for women during pregnancy with an elevated BMI.

Glutamate/glutamine and neuronal integrity in adults with ADHD: a proton MRS study.

There is increasing evidence that abnormalities in glutamate signalling may contribute to the pathophysiology of attention-deficit hyperactivity disorder (ADHD). Proton magnetic resonance spectroscopy ([1H]MRS) can be used to measure glutamate, and also its metabolite glutamine, in vivo. However, few studies have investigated glutamate in the brain of adults with ADHD naive to stimulant medication. Therefore, we used [1H]MRS to measure the combined signal of glutamate and glutamine (Glu+Gln; abbreviated as Glx) along with other neurometabolites such as creatine (Cr), N-acetylaspartate (NAA) and choline. Data were acquired from three brain regions, including two implicated in ADHD-the basal ganglia (caudate/striatum) and the dorsolateral prefrontal cortex (DLPFC)-and one 'control' region-the medial parietal cortex. We compared 40 adults with ADHD, of whom 24 were naive for ADHD medication, whereas 16 were currently on stimulants, against 20 age, sex and IQ-matched healthy controls. We found that compared with controls, adult ADHD participants had a significantly lower concentration of Glx, Cr and NAA in the basal ganglia and Cr in the DLPFC, after correction for multiple comparisons. There were no differences between stimulant-treated and treatment-naive ADHD participants. In people with untreated ADHD, lower basal ganglia Glx was significantly associated with more severe symptoms of inattention. There were no significant differences in the parietal 'control' region. We suggest that subcortical glutamate and glutamine have a modulatory role in ADHD adults; and that differences in glutamate-glutamine levels are not explained by use of stimulant medication.

Harnessing health information in the Third World.

The provision of technical information on health in developing countries is discussed, with particular reference to the Diarrhoeal Diseases Information Services Centre in Bangladesh. Progress towards meeting the pressing needs of the Third World in this field can undoubtedly be made by increasing the use of micrographic, computer and videodisc technologies and by reorganizing and promoting the facilities on offer.

PIP: The provision of health information in developing countries is hampered unless librarians act as facilitators for information-seekers. Awareness of the needs of users, of new technologies to meet these needs, of techniques of information retrieval, and of the necessity to provide access to information for all members of the health community is vital for the growth of viable health systems. Good examples of information dissemination at work are 1) the International Nutrition Centre in Central American and Panama filling 900 requests for information on child survival each year; 2) the Organisme de Recherches sur l'Alimentation et la Nutrition Africaines in Dakar, Senegal, publishing a list every 3 months of recent acquisitions in the field of nutrition and management of diarrhea; 3) the USAID-funded center to support health planning in Ouagadougou; 4) a multisectoral documentation center for the Sahel in Mali; 5) the International Water and Sanitation Centre in The Hague dispensing information on water and sanitation in developing countries; 6) the Center International de l'Enfance in Paris providing information on child health in 3 languages; 7) the Asian Institute of Technology in Bangkok coordinating for the Environment Sanitation Information Center; and 8) the Appropriate Health Resource sand Technologies Action Group publishing newsletters on health topics in 8 languages for 650,000 readers. Good sources of information on diarrheal disease are the Department of Community Medicine of Godjah Mada University in Indonesia and the Information Center on Diarrheal Disease of the Philippine Department of Health. An especially important information source is the Diarrheal Disease Information Services Center in Dhaka, Bangladesh. Established in 1982, this center is known for its regional and international networking. Funding from the Canadian International Development Research Centre permitted the purchase of computers; the publication of a quarterly journal on diarrhoeal disease, bibliographies, a directory of Asian specialists, and a review of research projects; as well as the development of a documents library. Additional funding, received in 1988 from the Swiss Development Cooperation, supported new programs including the acquisition of CD-ROM databases and the technology to create specific bibliographies on demand. Modern micrographic, computer, and videodisc technologies, allow developing countries to meet their communication needs while bypassing conventional methods. In large regions which lack adequate information facilities, politicians and administrators must be convinced of the importance of health literature services. Such service should be integrated at the national level and be brought to the attention of the local health community and the population at large.

Use of alfentanil with propofol for nasotracheal intubation without neuromuscular block.

We have investigated the effect of augmentation of propofol with alfentanil for nasotracheal intubation without neuromuscular block in 60 patients undergoing short elective maxillo-facial procedures as outpatients. After administration of glycopyrronium 5 micrograms kg-1 i.v., anaesthesia was induced with propofol 2.5 mg kg-1, or alfentanil 20 micrograms kg-1 and propofol 2.5 mg kg-1. The alfentanil group had improved jaw relaxation (P < 0.001) and vocal cord conditions (P < 0.005). Tracheal intubation was successful in 83% of patients receiving alfentanil, and in 73% of patients receiving propofol only. This difference was not significant. The cardiovascular response to intubation was attenuated in the alfentanil group.

Polyamine metabolism in 'green-islands' on powdery mildew-infected barley leaves: possible interactions with senescence.

Polyamine metabolism, lipoxygenase and catalase activities and ethylene production were examined in green-islands induced to form on detached barley leaves infected with the powdery mildew fungus, Erysiphe graminis f. sp. hordei Marchal. Several-fold increases in free polyamines were detected in green-islands, which could not be accounted for by changes in polyamine biosynthetic and degradative enzymes: a small increase in ornithine decarboxylase (ODC) activity, greatly decreased arginine decarboxylase (ADC) activity, virtually unchanged activity of S-adenosylmethionine decarboxylase (AdoMetDC) and greatly increased polyamine oxidase (PAO) activity. Changes in conjugated forms of polyamines suggest that elevated free polyamine concentrations might result from reductions in this pool. Green-island tissues displayed a reduced activity of lipoxygenase, unchanged catalase activity and a greatly lowered rate of ethylene production. Chlorophyll concentration and rates of photosynthesis and dark respiration were slightly increased in these tissues. In senescing regions of infected leaves, there was a small increase in free putrescine and spermine and a decrease in spermidine concentration, while concentrations of conjugated polyamines were substantially reduced. This was accompanied by an overall decrease in ODC and ADC activities and an increased activity of both AdoMetDC and PAO. These regions exhibited lowered lipoxygenase activity, greatly enhanced catalase activity and reduced rates of ethylene production. In addition, senescing regions exhibited a substantial reduction in chlorophyll concentration and the rate of photosynthesis, although dark respiration was similar to control values. These results support the view that green-islands represent areas of the infected leaf where senescence is retarded, biosynthetic activity is retained and in which polyamines may play an important role. On the other hand, although polyamine concentrations were reduced in senescing areas, other changes occurring there suggest that some functional integrity is maintained in that tissue.

Ozone-induced changes in CO2 assimilation, O2 evolution and chlorophyll a fluorescence transients in barley.

Spring barley (Hordeum vulgare cv. Klaxon) plants, 9 days old, were exposed to 0.05, 0.10 or 0.15 microl litre(-1) ozone (O3) for 12 days. Fumigation was administered for 7 h between 9.00 h and 16.00 h each day. Using conventional IRGA equipment, the carbon dioxide exchange rate (CER) was shown to decrease with increasing concentration of O3 during the exposure period, falling to 60% of the control value at the highest O3 concentration. Transpiration rates and stomatal conductance showed similar trends. Light saturation curves, obtained using a leaf disc oxygen electrode, demonstrated that O3-treated leaves had lower apparent quantum yields (QY) and generally lower rates of O2 evolution at saturating light and CO2 levels. Oscillations in chlorophyll a fluorescence, normally observed in control plants, could not be detected after O3 treatment and could only be restored to some extent by feeding the phosphate sequestering agent D-mannose to the leaves.