RESUMEN
BACKGROUND: Despite dramatic declines in prenatal maternal blood lead levels (BLLs) in most developed countries, little is known about the effects of extremely low-level (<1.0 µg/dL) lead exposure on fetal growth. METHODS: We measured maternal BLL during the second or third trimester of pregnancy and assessed birth outcomes, including birthweight, preterm birth (<37 gestational weeks) risk, small for gestational age births (SGA; birthweight <10th percentile) and low birthweight (LBW; <2500 g). The association between birthweight and maternal BLL was estimated using linear and quadratic spline models. Multivariable logistic models were used to examine the risk of binary responses. RESULTS: From 103 099 pregnant women, 20 000 blood samples were randomly selected for analysis. The maternal BLL range was 0.16-7.4 µg/dL, and the median was 0.63 µg/dL. After adjusting for covariates, the linear model showed that each 0.1 µg/dL increase in maternal BLL was associated with a 5.4 g decrease in mean birthweight [95% confidence interval (CI), 3.4 to 7.5 g]. The risk of SGA [adjusted odds ratio (aOR), 1.03; 95% CI, 1.02 to 1.05) and LBW (aOR, 1.03; 95% CI, 1.02 to 1.05) increased, whereas the risk of preterm delivery did not (aOR, 0.99; 95% CI, 0.97 to 1.02). CONCLUSIONS: Even at a maternal BLL below 1.0 µg/dL, prenatal lead exposure was associated with decreased birthweight and increased risk of SGA and LBW, but not preterm delivery. The adverse effect estimates of prenatal lead exposure on birth outcomes were quantitatively small and clinically limited at this low level.
Asunto(s)
Plomo , Nacimiento Prematuro , Niño , Estudios de Cohortes , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Japón/epidemiología , Embarazo , Nacimiento Prematuro/epidemiologíaRESUMEN
BACKGROUND: Loneliness in mothers raising children can adversely impact the health of their children and lead to child abuse, depression, and deterioration of mothers' health. Few studies to date have specifically assessed the association between loneliness and social factors, including the use of social network sites (SNSs), and personal factors. This study aimed to identify predictors of loneliness in mothers raising children, with special reference to SNS use. METHODS: This cross-sectional study involved an anonymous self-reported questionnaire survey of mothers participating in the health check-ups for their children in Nagahama City, Japan, from July 28 to September 29, 2014. The following items were assessed: revised UCLA Loneliness Scale, "Secure" subscale of the Internal Working Model Scale (IWMS-S), psychological distress scale (K6), abbreviated Lubben Social Network Scale (LSNS-6), and types of communication devices and information sources. Multiple regression analysis was performed using the Loneliness Scale score as the dependent variable. RESULTS: Among 763 mothers attending health check-ups for children in Nagahama City, 715 were available for the survey. Among a total of 638 respondents, data from 523 mothers were analyzed (valid response rate: 73.1%). The mean Loneliness Scale score ± standard deviation was 36.1 ± 9.7. The multiple regression analysis revealed that loneliness was significantly associated with being financially worse-off (ß = - 3.35, p = 0.004) and struggling (ß = - 2.47, p = 0.047); having a smaller family social network (ß = - 0.32, p = 0.032), having fewer friends (ß = - 0.49, p = 0.001), and having a smaller SNS network (ß = - 0.21, p = 0.018); a lower secure subscale score on the IWMS-S (ß = - 0.56, p < 0.001); and a K6 score of ≥5 (ß = 4.24, p < 0.001). CONCLUSION: The degree of loneliness in mothers raising children was associated with a smaller social network, lower secure attachment style, and a higher possibility of psychological distress. These factors should be considered when developing effective interventions against loneliness in mothers raising children.
Asunto(s)
Crianza del Niño/psicología , Trastorno Depresivo/etiología , Trastorno Depresivo/psicología , Soledad/psicología , Madres/psicología , Madres/estadística & datos numéricos , Estrés Psicológico , Adolescente , Adulto , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Japón , Masculino , Persona de Mediana Edad , Análisis de Regresión , Medios de Comunicación Sociales , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVES: After bills to launch the Social Security and Tax Number System were enacted in 2013, health and political officials have considered the Healthcare Number System (the System). However, little is known about doctors' awareness and concerns about the System. This study aimed to measure how many doctors disagree with the System, examine the doctors' characteristics, and analyze the benefits and harms of the System that they identified. METHODS: A cross-sectional survey was conducted of doctors via the Internet. The participants were selected from a convenience sample of a panel of doctors based on stratified sampling including four groups: working at a hospital and <45 years; working at a hospital and ≥45 years; working at a clinic and <45 years; and working at a clinic and ≥45 years. The main outcome was how many doctors agreed or disagreed with the System. The prevalence was calculated for each group, and their characteristics were examined using multivariable logistic regression analysis. The responses to open-ended questions concerning the Systems' benefits and harms were analyzed using qualitative content analysis. RESULTS: There were 562 respondents (68%). By group, 16/143 (11%), 25/138 (18%), 31/132 (23%), and 43/149 (29%) doctors, respectively, thought that the System was unnecessary. The variables that correlated with the main outcome were age (per 5 years; odds ratio [95% confidence interval], 1.14 [1.01-1.29]) and type of medical facility (working at a clinic; 1.99 [1.30-3.08]). The doctors identified that unifying information could decrease administrative duties, facilitate inter-facility collaboration, and prevent inappropriate medical consultations. This could result in decreased healthcare costs and personalized healthcare. However, the doctors also identified that integrating information and dealing with big data could increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information. This could result in deteriorating healthcare. Since some information should not be integrated, the System raises ethical considerations about privacy. CONCLUSION: Among the doctors surveyed here, 10-30% thought the System was unnecessary. These respondents tended to be older and work at a clinic. The System could decrease the cost of healthcare and enable personalized healthcare but could also increase information leakage and information management, cause over-monitoring of doctors, and enable the inappropriate use of integrated information. Prior to System introduction, we should facilitate consensus-building about protecting and utilizing personal information as well as consider the related ethical issues, and doctors' characteristics and concerns.