BackgroundGlobally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child morbidity and mortality. Inadequate water and sanitation access (WASH) are risk factors for PTB and LBW in low-income countries. Physical stress from carrying water and psychosocial stress from addressing sanitation needs in the open may be mechanisms underlying these associations. If so, then living in a community with strong social capital should be able to buffer the adverse effects of WASH on birth outcomes. The objective of this study is to assess the relationships between WASH access and social conditions (including harassment and social capital) on PTB and LBW outcomes among Indian women, and to test whether social conditions modified the association between WASH and birth outcomes.Methods and findingsThis cohort study examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012 Waves of the India Human Development Survey. PTB and LBW occurred in 14.9% and 15.5% of women, respectively. After adjusting for maternal biological and socioeconomic conditions, PTB was associated with sharing a building/compound latrine (Odds Ratio (OR) = 1.55; 95% Confidence Interval (CI) = 1.01, 2.38) versus private latrine access, but suggested an effect in the opposite direction for sharing a community/public latrine (OR = 0.67; CI = 0.45, 1.01). Open defecation, type of drinking water source, minutes per day spent fetching water, and one-way time to a drinking water source were not associated with PTB. LBW was associated with spending more than two hours per day fetching water compared to less than two hours (OR = 1.33; CI = 1.05, 1.70) and suggested an association with open defecation (OR = 1.22; CI = 1.00, 1.48), but was not associated with other types of sanitation, type of drinking water source, or time to a drinking water source. Harassment of women and girls in the community was associated with both PTB (OR = 1.33; CI = 1.09, 1.62) and LBW (OR = 1.26; CI = 1.03, 1.54). The data also showed a possible association of local crime with LBW (OR = 1.30; CI = 1.00, 1.68). Statistically significant (p<0.05) evidence of effect modification was only found for collective efficacy on the association between type of sanitation access and PTB. In addition, stratified analyses identified differences in effect size for walking time to the primary drinking water source and PTB by crime, sanitation access and PTB by harassment, and total hours per day fetching water and LBW by collective efficacy. Limitations of this observational study include risk of bias, inability to confirm causality, reliance on self-reported outcomes, and limited sub-group sample sizes for testing effect modification.ConclusionsThe relationship between adverse birth outcomes and sanitation access, domestic water fetching, crime, and gender-based harassment suggests physical and psychosocial stress are possible mechanisms by which WASH access affec...

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Objective: To examine the clinical characteristics and risk factors of patients with ST-elevation myocardial infarction (STEMI) <50 years old. Methods: All patients aged ≤ 50 years from March 2003 to June 2021 were enrolled from the prospective Minneapolis Heart Institute Level 1 STEMI database. Patient demographics, risk factors, comorbidities, medications use, illicit drug use, and lipid panel were analyzed by gender. Results: 908 patients were enrolled in the study (79.7% male, 88% Caucasian) and a minority had prior coronary artery disease (CAD) (Table 1). Risk factors included tobacco use (69%) and a family history of CAD (47%). Illicit drug use was rare (Table 2). Use of preventive medications was infrequent, including in those with established risk factors (Table 3). Median lipid levels were only mildly abnormal (Table 4). Conclusion: In younger patients with STEMI, smoking remains highly prevalent, rates of preventative medication use are low, and lipid levels alone may not effectively provide risk stratification.

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The prevalent use of bisphenol-A (BPA) in food containers, thermal paper, and other products provides an environmental challenge to the immune system of both humans and wildlife as BPA disrupts estrogen activity and alters signaling. We are exploring the impact of in vivo BPA exposure on innate immunity in both mice and zebrafish. Our earlier work in C57BL/6J mice showed that low dose, in vivo BPA exposure significantly decreases LPS-induced expression of CXCL-1, a chemokine that recruits neutrophils to the site of infection and the mouse homolog of human IL-8, in spleen cells. To determine if reduced chemokine secretion has a functional outcome, we expanded our studies to the zebrafish embryo model. Real time PCR analysis indicates that 4 to 6 day post fertilization (dpf) zebrafish exposed to environmentally relevant doses of BPA show reduced background expression of CXCL-8, the zebrafish homolog of mouse CXCL-1, and a reduction in the total number of neutrophils (4 dpf). BPA exposure also reduces the upregulation of CXCL-8 induced by a tail cut injury in 4 dpf zebrafish. MPO::GFP zebrafish expressing GFP under a neutrophil-specific myeloperoxidase promoter were used to track neutrophil movement for six hours following a tail cut injury. 4 dpf zebrafish exposed to BPA show a significantly reduced neutrophil recruitment to the site of injury compared to controls (p=0.004), a finding which correlates with the reduction in injury-induced CXCL-8 expression. Together our findings demonstrate that BPA exposure during early zebrafish development diminishes two key innate immune responses, thus potentially increasing susceptibility to infection.

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