Differential pulse oximetry readings between ethnic groups and delayed transfer to intensive care units.

BACKGROUND: Pulse oximeters are widely used to monitor blood oxygen saturations, although concerns exist that they are less accurate in individuals with pigmented skin. AIMS: This study aimed to determine if patients with pigmented skin were more severely unwell at the period of transfer to intensive care units (ICUs) than individuals with White skin. METHODS: Using data from a large teaching hospital, measures of clinical severity at the time of transfer of patients with COVID-19 infection to ICUs were assessed, and how this varied by ethnic group. RESULTS: Data were available on 748 adults. Median pulse oximetry demonstrated similar oxygen saturations at the time of transfer to ICUs (Kruskal-Wallis test, P = 0.51), although median oxygen saturation measurements from arterial blood gases at this time demonstrated lower oxygen saturations in patients classified as Indian/Pakistani ethnicity (91.6%) and Black/Mixed ethnicity (93.0%), compared to those classified as a White ethnicity (94.4%, Kruskal-Wallis test, P = 0.005). There were significant differences in mean respiratory rates in these patients (P < 0.0001), ranging from 26 breaths/min in individuals with White ethnicity to 30 breaths/min for those classified as Indian/Pakistani ethnicity and 31 for those who were classified as Black/Mixed ethnicity. CONCLUSIONS: These data are consistent with the hypothesis that differential measurement error for pulse oximeter readings negatively impact on the escalation of clinical care in individuals from other than White ethnic groups. This has implications for healthcare in Africa and South-East Asia and may contribute to differences in health outcomes across ethnic groups globally.

Access to a piped water supply is positively associated with haemoglobin levels in females living in rural Maharashtra State, India.

OBJECTIVES: There is a high prevalence of anaemia in individuals living in rural India, which may be modified by a number of environmental factors. The association between access to water, toileting facilities and healthcare services with the prevalence of anaemia was explored to determine potentially modifiable community-level risk factors. STUDY DESIGN: This was a cross-sectional survey. METHODS: Data were collected from adolescent females (aged 13-17 years) living in 34 villages in rural areas of the Maharashtra state of India on measures of sanitation facilities and access to health care along with haemoglobin measurements. Linear and logistic regression analyses were conducted to investigate associations between environmental (community) factors and adolescent haemoglobin levels and anaemia, respectively. RESULTS: Data were available from 1010 individuals, which represented a response rate of over 97% of those who were approached for the study. The prevalence of anaemia was very high (87%) when measured using haemoglobin levels. Access to a piped water supply was associated with 0.59 g/dL of increase in haemoglobin levels (95% confidence interval: 0.10-1.09). Associations between access to communal toilets, travel time to the hospital, health centres or nurses and haemoglobin levels or anaemia were not statistically significant. CONCLUSIONS: Anaemia prevalence was very high in our study population. Simple improvements such as provision of regular piped water is associated with an increase in haemoglobin levels in rural Indian females. These are consistent with the hypothesis that chronic exposure to higher levels of microbes in the living environment contributes to the risk of anaemia.

On the real-time prevention and monitoring of exertional heat illness in military personnel.

The proliferation of user-friendly low-cost wearable sensors has brought the concept of real-time physiological monitoring for exertional heat illness to the cusp of reality. This paper reviews and discusses the current state of the art in real-time physiological status monitoring for exertional heat illness mitigation within the military context. The review examines how both advanced sensor systems, models and algorithms are being combined in an international and collaborative way and how this is providing real solutions to military units to reduce the risk held by the commander. This paper provides additional detail into the process of integrating physiological status monitoring into military training, it explores the development of on-body sensors, the algorithms that can provide actionable information, the process of planning and dynamic risk assessment and describes some of the physiological monitoring systems that are currently being developed by the representative nations. It then discusses the knowledge gaps of how the technology will be integrated into military training, the importance of meaningful, accurate information that is both sensitive and specific and further developing the accuracy of the algorithms and models that are being employed. Finally, it talks about future direction and how individualizing physiological status monitoring can lead to performance enhancement in the form of individualized heat acclimatization programs. In conclusion, physiological status monitoring is at a stage of transition and integration where it can be used effectively to manage and reduce exertional heat illness to enable military personnel to train hard-train safe.

Mortality rates immediately after severe hurricanes in Cuba have decreased over the past three decades.

OBJECTIVES: The objective of this study is to understand how Cuba responds to extreme weather events, which can help identify and disseminate good public health practice. STUDY DESIGN: The study design of this study is an observational study using routinely collected mortality data. METHODS: National daily mortality counts after severe hurricanes arrived on the Cuba landmass since 1990 were compared with baseline values. Incidence rate ratios of mortality during the hurricane and for the four weeks afterwards were calculated for four eligible hurricanes: Georges (1998), Dennis (2005), Ike (2008) and Irma (2017). RESULTS: Mortality rates decreased over time (P < 0.001 for interaction), and no excess mortality counts were observed after Hurricane Irma in 2017. CONCLUSIONS: Mortality rates for severe hurricanes that have made landfall in Cuba have decreased over three decades, despite the most recent hurricane (Irma) being one of the strongest observed in recent decades. This suggests that the Cuban public health preparations and responses to recent severe hurricanes are probably contributing to this mitigation in national mortality rates during these periods.

Two measures of systemic inflammation are positively associated with haemoglobin levels in adolescent girls living in rural India: a cross-sectional study.

OBJECTIVE: This study tested the hypothesis that systemic inflammation is inversely associated with haemoglobin levels in adolescent girls in India. METHODS: The study population consisted of adolescent girls aged between 10 and 19 years living in a remote rural region in Maharashtra State, India. Data were collected on anthropometric measures, and a venous blood sample was taken and tested for complete blood count and C-reactive protein (CRP). RESULTS: Of 679 individuals who were invited to the research site to participate, data were available from 401 participants giving a response rate of 59%. Median blood CRP was 1.26 mg/l (Range 0.00 to 26.33), and 167 (41.6%) participants had CRP level < 1.0 mg/l. The mean haemoglobin was 12.24 g/dl (standard deviation [SD] 1.51), and the mean total white blood cells (WBC) count was 9.02 × 103 /µl (SD 2.00). With each g/dl increase in blood haemoglobin, the risk of having an elevated CRP of ≥ 1 mg/l increased with an odds ratio of 1.16 (95% CI 1.01 to 1.33, P = 0.03). Total WBC count was also positively associated with blood haemoglobin, increasing by 0.24 × 103 /µl (95% CI 0.11 to 0.37, P < 0.001) per g/dl increase in haemoglobin. Both analyses were adjusted for age. CONCLUSIONS: In this population, blood haemoglobin levels were positively associated with two measures of systemic inflammation, contrary to the primary hypothesis being tested. Other unmeasured environmental exposures may modify haemoglobin levels in this population. Understanding this observation may help design better public health interventions to improve the well-being of adolescent girls in India.

OBJECTIF: Cette étude a testé l'hypothèse selon laquelle l'inflammation systémique est inversement associée aux taux d'hémoglobine chez les adolescentes en Inde. MÉTHODES: La population étudiée était composée d'adolescentes âgées de 10 à 19 ans vivant dans une région rurale éloignée de l'Etat du Maharashtra, en Inde. Les données ont été collectées sur des mesures anthropométriques et un échantillon de sang veineux a été prélevé et testé pour la formule globulaire complète et la protéine C-réactive (CRP). RÉSULTATS: Sur 679 personnes qui ont été invitées au site de recherche à participer, des données étaient disponibles pour 401 participantes, soit un taux de réponse de 59%. La CRP sanguine médiane était de 1,26 mg/L (intervalle de 0,00 à 26,33) et 167 participantes (41,6%) avaient un taux de CRP <1,0 mg/L. L'hémoglobine moyenne était de 12,24 g/dL (écart-type [ET] 1,51), et le nombre moyen total de globules blancs (GB) était de 9,02 x103 /µL (ET 2,00). Avec chaque augmentation par g/dL de l'hémoglobine sanguine, le risque d'avoir une CRP élevée ≥1 mg/L augmentait avec un rapport de cotes de 1,16 (IC95%: 1,01 à 1,33, p = 0,03). La numération totale des GB était également positivement associée à l'hémoglobine sanguine, augmentant de 0,24 x103 /µL (IC95%: 0,11 à 0,37, p <0,001) par g/dL d'augmentation de l'hémoglobine. Les deux analyses ont été ajustées en fonction de l'âge. CONCLUSIONS: Dans cette population, les taux d'hémoglobine sanguine étaient positivement associés à deux mesures de l'inflammation systémique, contrairement à l'hypothèse principale testée. D'autres expositions environnementales non mesurées peuvent modifier les taux d'hémoglobine dans cette population. Comprendre cette observation peut aider à concevoir de meilleures interventions de santé publique pour améliorer le bien-être des adolescentes en Inde.

Patients' attitudes towards cost feedback to doctors to prevent unnecessary testing: a qualitative focus group study.

OBJECTIVES: There is a need to improve efficiency in healthcare delivery without compromising quality of care. One approach is the development and evaluation of behavioural strategies to reduce unnecessary use of common tests. However, there is an absence of evidence on patient attitudes to the use of such approaches in the delivery of care. Our objective was to explore patient acceptability of a nudge-type intervention that aimed to modify blood test requests by hospital doctors. STUDY DESIGN: Single-centre qualitative study. METHODS: The financial costs of common blood tests were presented to hospital doctors on results reports for 1 year at a hospital. Focus group discussions were conducted with recent inpatients at the hospital using a semi-structured question schedule. Discussions were transcribed and analysed using qualitative content analysis to identify and prioritise common themes explaining attitudes to the intervention approach. RESULTS: Three focus groups involving 17 participants were conducted. Patients were generally apprehensive about the provision of blood test cost feedback to doctors. Attitudes were organised around themes representing beliefs about blood tests, the impact on doctors and their autonomy, and beliefs about unnecessary testing. Patients thought that blood tests were important, powerful and inexpensive, and cost information could place doctors under additional pressure. CONCLUSION: The findings identify predominantly positive beliefs about testing and negative attitudes to the use of financial costs in the decision-making of hospital doctors. Public discussion and education about the possible overuse of common tests may allow more resources to be allocated to evidence-based healthcare, by reducing the perception that such strategies to improve healthcare efficiency negatively impact on quality of care.

Worries and concerns about hypoglycemia in adults with type 1 diabetes: An examination of the reliability and validity of the Hypoglycemic Attitudes and Behavior Scale (HABS).

AIMS: To examine the factor structure, validity and reliability of the Hypoglycemic Attitudes and Behavior Scale (HABS) in T1D adults (previously examined only in T2D adults), and to determine if it has unique value, after controlling for hypoglycemic fear. METHODS: The original 14 HABS items were submitted to a confirmatory factor analysis (CFA) with T1D participants. Construct validity criteria included diabetes distress, generalized anxiety, well-being, hypoglycemic fear, hypoglycemia history and self-reported glycemic control. RESULTS: A CFA yielded a similar 3-factor solution, with all items loading on the same factors as in the analyses with T2D adults: Hypoglycemia Anxiety, Avoidance and Confidence. Higher levels of Anxiety and Avoidance were significantly associated with poorer well-being and higher levels of generalized anxiety, diabetes distress and hypoglycemic fear, with correlations in the reverse direction for Confidence. After controls (including hypoglycemic fear), the HABS subscales were significantly linked to several criterion variables. CONCLUSIONS: Though originally developed and validated with T2D adults, the HABS demonstrates sufficient validity and reliability for use with a T1D population; and it captures unique critical elements of hypoglycemic concerns. Thus, it may contribute to a greater understanding of hypoglycemia management and more targeted clinical interventions in a T1D population.

Prevalence of and factors associated with Helicobacter pylori infection in preschoolers in Havana, Cuba: A population-based study. / Prevalencia y factores asociados a infección por Helicobacter pylori en preescolares de La Habana, Cuba. Estudio de base poblacional.

INTRODUCTION: Helicobacter pylori (H. pylori) infection is usually acquired in childhood. In Cuba, its study in pediatric ages is a little explored field. AIM: To identify the prevalence of the infection and its associated risk factors in 3-year-old children in Havana. MATERIALS AND METHODS: An analytic, cross-sectional, epidemiologic analysis was conducted on 1,274 children belonging to the cohort of participants in the Natural History of Wheezing in Cuba study (HINASIC for its Spanish acronym) that were 3 years of age and provided a stool sample. H. pylori infection was identified by determining the H. pylori antigen (Ag) in stool, utilizing the commercial Spinreact kit, from Spain. The data were collected through a questionnaire applied by the researchers that included sociodemographic, environmental, and lifestyle variables, as well as infection from other parasites. Prevalence and the prevalence ratio with a 95% confidence interval were calculated and the dichotomous logistic regression analysis was employed. RESULTS: The prevalence of positive H. pylori Ag was 5%. Sleeping together was the risk factor found (PR:1.27; 95% CI: 1.03-1.50). Protective factors were drinking water from water delivery trucks (PR: 0.16; 95% CI: 0.04-0.72) and living in a nuclear family unit (PR: 0.94; 95% CI: 0.85-0.99). CONCLUSIONS: The prevalence of H. pylori infection in early childhood places Havana in an intermediate position at the international level. To control the infection, causal studies should be conducted and opportune interventions implemented.

Pathogen displacement during intermittent catheter insertion: a novel in vitro urethra model.

AIM: To develop a novel in vitro urethra model and use it to determine if insertion of an intermittent urinary catheter (IC) displaces pathogenic bacteria from the urethral meatus along the urethra. METHODS: Displacement of microbial growth after catheter insertion was assessed using a novel in vitro urethra model. The in vitro urethra model utilized chromogenic agar and was inoculated with bacteria at one side of the artificial urethra channel, to act as a contaminated urethral meatus, before an IC was inserted into the channel. Three ICs types were used to validate the in vitro urethra model and methodology. RESULTS: When compared to the bacterial growth control, a significant difference in bacterial growth was found after insertion of the uncoated (P ≤ 0·001) and hydrophilic coated (P ≤ 0·009) catheters; no significant difference when a prototype catheter was inserted into the in vitro urethra model with either bacterial species tested (P ≥ 0·423). CONCLUSION: The results presented support the hypothesis that a single catheter insertion can initiate a catheter-associated urinary tract infection. SIGNIFICANCE AND IMPACT OF THE STUDY: The in vitro urethra model and associated methodology were found to be reliable and reproducible (P ≥ 0·265) providing new research tool for the development and validation of emerging technologies in urological healthcare.

Prevalence and risk factors for initiating tobacco and alcohol consumption in adolescents living in urban and rural Ethiopia.

OBJECTIVES: African countries are potential high growth markets for the alcohol and tobacco industries. This study aimed to identify exposures that are associated with initiating use of alcohol and tobacco products in young people living in Ethiopia. As televised football and Internet viewing are media through which products can be promoted to this population efficiently, these risk factors were of particular interest. STUDY DESIGN: This is a cross-sectional study. METHODS: Data were collected using a self-administered questionnaire of 3967 children aged 13-19 years in 20 high schools in urban and rural Ethiopia on consumption and risk factors for alcohol and tobacco use in 2016, as well as exposure to potential sources of advertising. RESULTS: Eight percent of respondents reported having ever smoked and 3% were current smokers. Twenty-nine percent reported ever having used alcohol, and 14% were current users. Risk factors for ever smoking included father smoking (odds ratio [OR] 1.95; 95% confidence interval [CI]: 1.21 to 3.15), mother smoking (OR 3.90; 95% CI: 1.63 to 9.33), best friend smoking (OR 5.86; 95% CI: 4.31 to 7.96) and home Internet access (OR 1.75; 95% CI: 1.35 to 2.27). There was a very strong positive association between ever having smoked cigarettes and ever having tried alcohol (P < 0.001). Risk factors for currently drinking alcohol included father drinking (OR 1.45; 95% CI: 1.05 to 2.01), mother drinking (OR 2.00; 95% CI: 1.44 to 2.77), home Internet access (OR 1.53; 95% CI: 1.24 to 1.90) and regular watching of televised football (OR 2.44 compared to those who do not; 95% CI: 1.58 to 3.78). CONCLUSIONS: As in rich countries, tobacco and alcohol use among Ethiopian teenagers increases among those exposed to family and peer use but are also more common among those accessing the Internet and, for alcohol, those watching televised football. The effect of watching televised football on alcohol use, at least, is likely to be due to exposure to advertising.

What is the association between price and economic activity with cigarette consumption in Cuba from 1980 to 2014?

OBJECTIVES: Cuba is a tobacco-producing country that has been economically isolated as a consequence of an embargo imposed by the USA. It has also experienced a severe economic depression in the 1990s after the withdrawal of support by the former Soviet Union. These characteristics provide a unique opportunity to study the relation between large changes in economic activity, cigarette price and demand for cigarettes in a relatively isolated socialist economy. STUDY DESIGN: This is an observational epidemiological study. METHODS: Data were obtained on the annual price of a packet of cigarettes and the mean number of cigarettes consumed per adult living in Cuba from 1980 to 2014. Descriptive and regression analysis were used to explore the relationship between cigarette consumption and price in Cuba. RESULTS: In 1980, the mean price of a packet of cigarettes was 1.53 Cuban peso (CUP) in 1997 prices and the mean annual per capita consumption was 2237 cigarettes. In 2014, the mean price had increased to 5.57 CUP (1997 prices) per packet of cigarettes, and consumption had fallen to 1527 cigarettes per capita. There were significant negative associations between annual cigarette consumption and both price and living through an economic depression. The elasticity was approximately -0.31 with price, and living through an economic depression was also associated with lower consumption of cigarettes (a reduction of 9%, 95% confidence intervals -0.18 to -0.001). CONCLUSIONS: Higher cigarette pricing, along with other public health interventions, are required to protect the national population from the adverse effects of tobacco smoke exposure.

Association between infection with Helicobacter pylori and atopy in young Ethiopian children: A longitudinal study.

BACKGROUND: Epidemiological evidence from developed countries indicates that Helicobacter pylori infection correlates with a reduced risk of atopy and allergic disorders; however, limited data are available from low-income countries. OBJECTIVE: We examined associations between H. pylori infection in early childhood and atopy and reported allergic disorders at the age of 6.5 years in an Ethiopian birth cohort. METHODS: A total of 856 children (85.1% of the 1006 original singletons in a population-based birth cohort) were followed up at age six and half years. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were based on the International Study of Asthma and Allergies in Children (ISAAC) core allergy and environmental questionnaire. Serum samples were analysed for total IgE levels and anti-H. pylori cytotoxin-associated gene A (CagA) IgG antibody using commercially available ELISA kits. Stool samples were analysed for H. pylori antigen using a rapid immunochromatographic test. The independent effects of H. pylori infection (measured at age of 3, 5 and 6.5 years) on prevalence and incidence of atopy and reported allergic disorders (measured at age of 6.5 years) were determined using multiple logistic regression. RESULTS: In cross-sectional analysis, current H. pylori infection at age 6.5 years was inversely, though not significantly, related to prevalence of atopy and "any allergic condition" at age 6.5 years. However, detection of H. pylori infection at any point up to age 6.5 years was associated with a significantly reduced odds of both atopy and "any allergic condition" (adjusted OR AOR, 95% CI, 0.54; 0.32-0.92, P = .02, and .31; 0.10-0.94, P = .04, respectively). In longitudinal analyses, H. pylori infection at age 3 was inversely associated with incidence of atopy (AOR, 95% CI, 0.49; 0.27-0.89, P = .02). Furthermore, among H. pylori-infected children, those with a CagA+ strain had a more pronounced reduction in odds of atopy (AOR = 0.35 vs 0.63 for CagA+ vs CagA-), and this reduction reached borderline significance. CONCLUSION: These data are consistent with the hypothesis that early exposure to H. pylori is inversely associated with atopy and allergic conditions. A possible modest protective association against atopy was observed in those infected with a more virulent CagA+ strain of H. pylori.

Risk factors for maternal anaemia and low birth weight in pregnant women living in rural India: a prospective cohort study.

OBJECTIVE: The aim of this prospective study was to estimate the prevalence and risk factors for maternal anaemia and low birth weight (LBW) in pregnant women living in Maharashtra state, India. STUDY DESIGN: This is a prospective study. METHODS: Women between 3 and 5 months of pregnancy were recruited from 34 villages based in Maharashtra state. Baseline data collection, anthropometric measurements and blood investigations were performed. Participants were followed-up to record birth weight. RESULTS: In total, 303 women were eligible, and 287 (95%) provided data. 77% were anaemic, defined as haemoglobin less than 11.0 g/dl at the time of recruitment, with a mean corpuscular volume of 80.5 fl/cell (standard deviation: 7.22, range: 53.4-93.8). The increased risk of anaemia was seen in women with consanguineous marriages (odds ratio [OR]: 2.41, 95% confidence interval [CI]: 1.16-5.01, P = 0.01) after adjustment for potential confounding factors. Postdelivery data from full-term singleton live births demonstrated a 7% prevalence of LBW. Consanguineous marriage was a major risk factor for LBW (OR: 4.10, 95% CI: 1.25-13.41, P = 0.02). The presence of maternal anaemia during 3-5 months of pregnancy was associated with lower risk of LBW (unadjusted OR: 0.34, 95% CI: 0.13-0.92, P = 0.03). CONCLUSION: About 30% of our study participants were in a consanguineous marriage, which was identified as a potentially avoidable risk factor for both anaemia and LBW.

Household air pollution and lung function in Indian adults: a cross-sectional study.

Exposure to air pollution produced by cooking is common in developing countries, and represents a potentially avoidable cause of lung disease. Cross-sectional data were collected by the World Health Organization's Study on Global AGEing and Adult Health conducted in India between 2007 and 2010. Exposure to biomass cooking was also associated with a decrease in forced expiratory volume in 1 s (FEV1) (-70 ml, 95%CI -111 to -30) and FEV1/FVC (forced vital capacity) ratio (-0.025, 95%CI -0.035 to -0.015) compared to those who were not exposed. These associations were predominantly observed in males (P < 0.05 for interaction analyses). Intervention studies using non-biomass fuels in India are required to ascertain potential respiratory health benefits.

sTREM-1 is elevated in cystic fibrosis and correlates with proteases.

BACKGROUND: sTREM-1 (soluble triggering receptor expressed on myeloid cells-1) is a novel inflammatory marker that may be of clinical use in cystic fibrosis (CF). Dysregulation of the TREM pathway has been demonstrated in other inflammatory diseases and modulation in animal models has therapeutic benefit. We hypothesised that sTREM-1 could act as a biomarker of disease in cystic fibrosis. METHODS: Plasma from 17 patients with CF (stable and pre and post pulmonary exacerbation) and eight healthy volunteers was analyzed for sTREM-1 and proteases (matrix metalloproteinase-8 (MMP-8), MMP-9, and human neutrophil elastase HNE). RESULTS: sTREM-1 Levels were elevated in stable CF subjects compared to controls (148 pg/ml (130-160) [median(IQR)] vs. 87 (55-118) (P < 0.01)) but were not further increased during pulmonary exacerbation nor decreased after antibiotic treatment in CF. Protease levels were increased in CF plasma compared to controls: MMP-8 = 3.1 ng/ml (1.5-7.6) vs. 0.3 (0.18-0.53) (P < 0.01) (Wilcoxon); MMP-9 = 170 ng/ml (124-282) vs. 49 (39-90) (P < 0.01); HNE = 30.2 ng/ml (22.7-30.9) vs. 17.5 (11.2-22.2) (P < 0.05). sTREM-1 correlated positively with protease levels lnMMP-8 r2 = 0.55 (P = 0.08), lnMMP-9 r2 = 0.61(P < 0.05), lnHNE r2 = 0.35 (P < 0.05). CONCLUSIONS: sTREM-1 is constitutively elevated in CF and positively correlates with protease levels. Modulation of this pathway may be of therapeutic benefit to patients with CF. Pediatr Pulmonol. 2017;52:467-471. © 2017 Wiley Periodicals, Inc.

Prevalence of iron-deficiency anaemia and risk factors in 1010 adolescent girls from rural Maharashtra, India: a cross-sectional survey.

OBJECTIVE: Iron-deficiency anaemia (IDA) is the most common nutritional disorder observed in adolescent girls in India. Our aim was to investigate the prevalence and risk factors associated with IDA in rural Maharashtra, India, to address current evidence gaps. STUDY DESIGN: Cross-sectional survey. METHODS: The study recruited 13- to 17-year-old adolescent girls living in 34 villages of Osmanabad district. Data were collected on individual health, dietary, sociodemographic factors, and anthropometric measurements were taken. Haemoglobin (Hb) levels were measured using Sahli's haemometer. Logistic and linear regressions were used to identify risk factors associated with IDA and Hb levels, respectively. RESULTS: Among 1010 adolescent girls (response rate 97.5%), the mean Hb was 10.1 g/dl (standard deviation = 1.3), and 87% had anaemia (Hb < 12 g/dl). The prevalence of mild (11.0-11.9 g/dl), moderate (8.0-10.9 g/dl) and severe (Hb ≤ 7.9 g/dl) anaemia was 17%, 65% and 5%, respectively. Anaemia likelihood increased significantly with age (odds ratio (OR): 1.41 per year, 95% confidence interval (CI): 1.17-1.70). Factors associated with decreased anaemia risk were mid-upper arm circumference (MUAC) ≥22 cm (OR: 0.51, 95% CI: 0.31-0.82), ≥3 days/week consumption of fruit (OR: 0.35, 95% CI: 0.23-0.54) or rice (OR: 0.39, 95% CI: 0.17-0.91), and incomplete schooling (OR: 0.47, 95% CI: 0.24-0.91). In the final model lower age, MUAC and fruit consumption were significantly associated with Hb level. CONCLUSION: Anaemia prevalence was extremely high among adolescent girls in rural areas of Maharashtra. Whilst we identified risk factors that could be used for targeting interventions, there is urgent need of comprehensive preventative interventions for the whole adolescent girl population.

Silver nanoparticles in the environment: Sources, detection and ecotoxicology.

The environmental impact of silver nanoparticles (AgNP) has become a topic of interest recently, this is due to the fact that AgNPs have been included in numerous consumer products including textiles, medical products, domestic appliances, food containers, cosmetics, paints and nano-functionalised plastics. The production, use and disposal of these AgNP containing products are potential routes for environmental exposure. These concerns have led to a number of studies investigating the release of particles from nano-functionalised products, the detection of the particles in the aquatic environment and the potential environmental toxicology of these AgNPs to aquatic organisms. The overall aim of this review is to examine methods for the capture and detection of AgNPs, potential toxicity and transmission routes in the aquatic environment.