A quarter of all global neonatal deaths occur in India. Congenital anomalies constitute the fifth largest cause of neonatal mortality in the country, but national estimates of the prevalence of these ...conditions are lacking. The objective of the study was to derive an estimate of the birth prevalence of congenital anomalies in India.
The search was carried out in PubMed and pooled prevalence was estimated using the inverse variance method. A random effects model was used due to high heterogeneity between the studies. Forest plots were generated using the Review Manager software.
The PubMed search identified 878 articles from which 52 hospital based and three community based studies were included in the meta-analysis. The pooled prevalence of congenital anomaly affected births was 184.48 per 10,000 births (95% CI 164.74-204.21) among 802,658 births. Anomalies of the musculoskeletal system were highest among live births while the prevalence of central nervous system defects was highest when stillbirths were included in the analysis. Anencephaly and talipes were the most commonly reported anomalies.
Data from this meta-analysis suggests that there may be as many as 472,177 (421,652 to 522,676) congenital anomaly affected births in India each year. Population based studies using standard definitions are needed to validate these estimates. The two most frequently reported anomalies were anencephaly that is potentially preventable through preconception folate supplementation, and talipes which can be corrected using relatively low cost interventions. Studies are needed to determine the impact of congenital anomalies on neonatal mortality in India.
India lacks a national birth defects surveillance. Data on the prevalence of congenital anomalies are available mostly from hospital-based, cross-sectional studies. This is the first cohort study ...from India, where 2107 women were followed till pregnancy outcome, in order to measure the prevalence and types of congenital anomalies, their contribution to neonatal mortality, implications for surveillance, and the health service needs for prevention and management.
The study followed a cohort of 2107 pregnant women till outcome which was miscarriage, termination of pregnancy, live or stillbirth, neonatal and post-neonatal mortality. Case ascertainment of congenital anomalies was done through visual examination, followed by various investigations. Rates of congenital anomaly affected births were reported per 10 000 births. Health service needs were described through retrospective analysis of events surrounding the diagnosis of a congenital anomaly.
Among 1822 births, the total prevalence of major congenital anomalies was 230.51 (170.99-310.11) per 10 000 births. Congenital heart defects were the most commonly reported anomalies in the cohort with a prevalence of 65.86 (37.72-114.77) per 10 000 births. Although neural tube defects were two and a half times less as compared to congenital heart defects, they were nevertheless significant at a prevalence of 27.44 (11.73-64.08) per 10 000 births. In this cohort, congenital anomalies were the second largest cause of neonatal deaths. The congenital anomaly prenatal diagnosis prevalence was 10.98 per 1000 births and the congenital anomaly termination of pregnancy rate was 4.39 per 1000 births.
This first cohort study from India establishes that the congenital anomaly rates were high, affecting one in forty four births in the cohort. The prevalence of congenital anomalies was identical to the stillbirth prevalence in the cohort, highlighting their public health importance. The results of this study identify the need for a well defined national programme with components of prevention, care and surveillance.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
A large number of studies have reported that the prevalence of beta thalassemia carriers in India varies by ethnic groups. The objective of this study was to conduct a systematic review of the ...published studies and conduct a meta-analysis to determine the prevalence of beta thalassaemia carriers in India. A PubMed database search using keywords “beta thalassaemia AND India” identified 1088 articles of which 69 articles were included in the review. Studies using diagnostic tests and methods recommended by the International Council for Standardization in Haematology were used for calculation of pooled prevalence. Pooled prevalence was calculated using a random effects model using Review Manager version 5.3. Studies had screened five categories of populations, that is, the general population; tribal groups, communities not belonging to tribal groups, persons with anemia, and persons referred with a suspicion of hemoglobinopathy. This heterogeneity contributed to a high pooled prevalence of beta thalassemia carriers of 8.23% (95% CI 7.36–9.10). Sub-group analysis however yielded 3.74% (95% CI 2.52–4.97) pooled prevalence of beta thalassemia carriers in the general population. It was 4.6% (95% CI 3.2–6.2) among tribal groups. Quality of prevalence studies was limited by methodological issues including non-random sampling methods, heterogeneity of population types screened, and lack of use of recommended diagnostic cut-offs. Prevalence of beta thalassemia carriers was similar in tribal populations and the general population, indicating the need to further investigate the prevalence of beta thalassemia carriers in tribal groups.
An important rationale for legally farmed and synthetic wildlife products is that they reduce illegal, wild‐sourced trade by supplying markets with sustainable alternatives. For this to work, more ...established illegal‐product consumers must switch to legal alternatives than new legal‐product consumers switch to illegal wild products. Despite the widespread debate on the magnitude and direction of switching, studies among actual consumers are lacking. We used an anonymous online survey of 1421 traditional Chinese medicine consumers in China to investigate switching among legal farmed, synthetic, and illegal wild bear bile. We examined the past consumption behavior, applied a discrete choice experiment framed within worsening hypothetical disease scenarios, and used latent class models to investigate groups with shared preferences. Bear bile consumers (86% respondents) were wealthier, more likely to have family who consumed bile, and less knowledgeable about bile treatments than nonconsumers. Consumer preferences were heterogenous, but most consumer preferences switched between bile types as disease worsened. We identified five distinct latent classes within our sample: law‐abiding consumers (34% respondents), who prefer legal products and were unlikely to switch; two all‐natural consumer groups (53%), who dislike synthetics but may switch between farmed and wild; and two nonconsumer groups (12%), who prefer not to buy bile. People with past experience of bile consumption had different preferences than those without. Willingness to switch to wild products was related to believing they were legal, although the likelihood of switching was mediated by preferences for cheaper products sold in legal, familiar places. We found that consumers of wild bile may switch to legal alternatives, given the availability of a range of products, whereas legal‐product consumers may switch to illegal products if the barriers to doing so are small. Understanding preferences that promote or impede switching should be a key consideration when attempting to predict consumer behavior in complex wildlife markets.
La Importancia de Comprender Por Qué los Consumidores en China Cambian entre Productos de Bilis de Oso Silvestre, Criado y Productos Sintéticos
Resumen
Una razón importante detrás de los productos faunísticos de crianza legal y los productos sintéticos es que reducen el mercado ilegal de origen silvestre al proporcionarles alternativas sustentables a los mercados. Para que esto funcione, deben ser más los consumidores establecidos de productos ilegales que cambian a las alternativas legales que los consumidores nuevos de productos legales que cambian a productos silvestres ilegales. A pesar del debate extenso sobre la magnitud y dirección del cambio, los estudios sobre consumidores reales son deficientes. Encuestamos en línea a 1421 consumidores anónimos de medicina tradicional china en ese país para investigar los cambios entre bilis de oso silvestre e ilegal, sintética y criada legalmente. Examinamos el comportamiento pasado de los consumidores, aplicamos un experimento de elección discreta enmarcado dentro de escenarios de agudizamiento de enfermedades, y usamos modelos latentes de clase para investigar a los grupos con preferencias compartidas. Los consumidores de bilis de oso (86% de los respondientes) resultaron ser más adinerados, con mayor probabilidad de tener familiares que consumen bilis y menos conocedores sobre los tratamientos con bilis que los no consumidores. Las preferencias de los consumidores fueron heterogéneas, aunque la mayoría de éstas cambiaba de tipo de bilis conforme la enfermedad empeoraba. Identificamos cinco clases latentes distintivas dentro de nuestra muestra: los consumidores que respetan las leyes (34% de los respondientes), quienes prefieren los productos legales y probablemente no cambiarían de tipo de producto; dos grupos de consumidores de productos naturales (53%), quienes no gustan de los productos sintéticos, pero podrían cambiar entre aquellos de crianza y silvestres; y dos grupos de no consumidores (12%), quienes prefieren no comprar bilis. Las personas con experiencia previa en el consumo de bilis tuvieron preferencias diferentes a aquellas sin experiencia. La voluntad por cambiarse a productos de origen silvestre estuvo relacionada con la creencia de que fueran legales, aunque la probabilidad de cambiar estuvo mediada por la preferencia por productos más baratos vendidos en lugares legales y conocidos. Descubrimos que los consumidores de bilis silvestre pueden cambiar a las alternativas legales dada la disponibilidad de una gama de productos, mientras que los consumidores de productos legales pueden cambiar a los productos ilegales si las barreras para hacerlo son menores. El entendimiento de las preferencias que promueven o impiden estos cambios debería ser una consideración importante cuando se intente predecir el comportamiento del consumidor dentro de los mercados complejos de fauna.
Article Impact Statement: Wildlife consumer characteristics and preferences determine their likelihood and direction of switching between legal and illegal products.
摘要
了解中国消费者在野生、饲养和合成的含熊胆药品/制品之间“转换”的原因
对于合法饲养和合成的野生动物产品而言, 一个重要的原因在于其可通过为市场提供可持续的替代品来减少非法野生来源的贸易。为实现这一点, 转向合法替代品的固有非法产品消费者必须多于新增的转向非法野生产品的合法产品消费者。尽管关于转换的规模与方向有着广泛的讨论, 但仍缺乏对实际消费者的研究。我们通过对中国 1421 名中药消费者的在线匿名调查来探究在合法饲养、合成和非法野生的含熊胆药品/制品之间存在的转换。我们调查了过去的消费行为, 同时在假设的疾病逐步恶化的情景中应用了离散选择实验, 并使用潜在类别模型来研究具有共同偏好群体的特征。含熊胆药品/制品的消费者(86% 的受访者)与非消费者相比经济条件更优、更有可能其家人有过此类消费, 并且对含熊胆药品/制品的治疗方面的了解更少。消费者的偏好是异质的, 但随着疾病的恶化, 大多数消费者更倾向于在不同类型的含熊胆药品/制品之间进行转换。我们在样本中确定了五个不同的潜在人群类别:“守法消费者”(34% 的受访者), 他们更喜欢合法产品并且不太可能转换;两个“纯天然消费者”群体(53%), 他们不喜欢合成的产品, 但可能会在饲养和野生的产品之间转换;以及两个不喜欢购买含熊胆药品/制品的“非消费者”群体(12%)。有过含熊胆药品/制品消费经历的群体与没有消费过的人群有着不同的偏好。尽管转换的可能性会受到对在合法、熟悉地方销售的低价产品偏好的调节影响, 但转向野生产品的意愿与认为其是合法的有关。我们的研究表明, 考虑到一系列合法替代品的可获得性, 野生熊胆的消费者可能会转向合法产品, 而如果转换的阻碍很小, 原本合法产品的消费者也可能会转向非法产品。在复杂的野生动物市场中尝试预测消费者的行为时, 了解可促进或阻碍转换的偏好特征是一个需要考虑的至关重要因素。
Mandatory food fortification with folic acid Kar, Anita; Yajnik, C S; Doke, P P ...
The Lancet global health,
October 2022, 2022-10-00, 20221001, 2022-10-01, Letnik:
10, Številka:
10
Journal Article
The leukemic cells of patients with chronic lymphocytic leukemia (CLL) are often unique, expressing remarkably similar IGHV-IGHD-IGHJ gene rearrangements, "stereotyped BCRs". The B-cell receptors ...(BCRs) on CLL cells are also distinctive in often deriving from autoreactive B lymphocytes, leading to the assumption of a defect in immune tolerance.
Using bulk and single-cell immunoglobulin heavy and light chain variable domain sequencing, we enumerated CLL stereotype-like IGHV-IGHD-IGHJ sequences (CLL-SLS) in B cells from cord blood (CB) and adult peripheral blood (PBMC) and bone marrow (BM of healthy donors. CLL-SLS were found at similar frequencies among CB, BM, and PBMC, suggesting that age does not influence CLL-SLS levels. Moreover, the frequencies of CLL-SLS did not differ among B lymphocytes in the BM at early stages of development, and only re-circulating marginal zone B cells contained significantly higher CLL-SLS frequencies than other mature B-cell subpopulations. Although we identified CLL-SLS corresponding to most of the CLL major stereotyped subsets, CLL-SLS frequencies did not correlate with those found in patients. Interestingly, in CB samples, half of the CLL-SLS identified were attributed to two IGHV-mutated subsets. We also found satellite CLL-SLS among the same normal samples, and they were also enriched in naïve B cells but unexpectedly, these were ~10-fold higher than standard CLL-SLS. In general, IGHV-mutated CLL-SLS subsets were enriched among antigen-experienced B-cell subpopulations, and IGHV-unmutated CLL-SLS were found mostly in antigen-inexperienced B cells. Nevertheless, CLL-SLS with an IGHV-mutation status matching that of CLL clones varied among the normal B-cell subpopulations, suggesting that specific CLL-SLS could originate from distinct subpopulations of normal B cells. Lastly, using single-cell DNA sequencing, we identified paired IGH and IGL rearrangements in normal B lymphocytes resembling those of stereotyped BCRs in CLL, although some differed from those in patients based on IG isotype or somatic mutation.
CLL-SLS are present in normal B-lymphocyte populations at all stages of development. Thus, despite their autoreactive profile they are not deleted by central tolerance mechanisms, possibly because the level of autoreactivity is not registered as dangerous by deletion mechanisms or because editing of L-chain variable genes occurred which our experimental approach could not identify.
Surging demand for medicinal plant products may lead to unsustainable harvesting practices, which could put pressure on wild populations. Yet little is known about indigenous harvesters' preferences ...on key traditional Chinese medicinal plant resources, and how these might affect sustainable use and management.
We conducted a discrete choice experiment with over 900 native Tibetan harvesters in the eastern Qinghai–Tibetan plateau in China, under a range of complex alternative livelihood, climate and environmental change, and land tenure and customs scenarios.
We used random parameter logit model with broad heterogeneity to estimate local Tibetan harvesters' preferences and their willingness to harvest, and latent class logit model to explore distinct within‐population groupings based on shared preferences, for designing possible interventions.
We uncovered three key findings with important management implications for medicinal plants. When given a choice, the local harvesters preferred not to harvest any herbs. However, if they opted to harvest, they preferred to harvest flowers and seeds, as compared to roots, and tended to use wooden tool (over the use of bare hands and iron tool).
Notably, the degree of compliance with village rules and customs, and ecological worldview interact with targeted plant parts and potential income from harvest to influence their harvesting preferences. Their choices were sensitive to scenario‐based changes to livelihood options.
Finally, our study revealed three distinct harvester groups with substantial heterogeneity. Specifically, two groups consisted of over 60% of the interviewed harvesters who appeared to have a strong preference for sustainable practices, while the remaining group lacks this tendency.
Overall, our results shed light on the importance of understanding the drivers of harvesting preferences and the heterogeneity of harvesting practices among indigenous people and their cultural and sustainability leanings, providing crucial insights for future sustainable use and management of wild and economically important medicinal plants in the grasslands of Qinghai–Tibetan Plateau and other regions.
Read the free Plain Language Summary for this article on the Journal blog.
ནང་དོན་གནད་བསྡུས
近年来，全球范围内对于中草药的需求激增，导致不可持续的采集实践频发。但目前关于采集者对于药用植物的采集偏好，以及如何影响可持续利用和管理仍知之甚少。本章节主要有三个对于可持续管理至关重要的发现: (1)当有其它选择时，相较于选择一种植物采集，当地人更倾向于不采集任何的植物。且当选择采集一种植物时，藏族采集者也更倾向与采集所需部位为花朵和种子的植物，而不是根类植物。使用工具方面，相较于大型铁制工具，藏族采集者更倾向于使用传统的木制工具；(2)村规民约的遵守程度和生态观与采集部位和采集收入对采集偏好具有交互效应，此外采集者的采集偏好对于生计变化最为敏感，对其它类别的情景影响不显著；(3)本研究揭示了三个不同的采集者群体，具有显著的异质性。具体而言，超过60%的人对可持续做法有强烈的偏好，而剩余一组则没有可持续采集倾向。综上所述，本章内容揭示了本地人采集偏好的驱动因素和采集实践的异质性， 旨在为未来青藏高原地区和其他资源分布地区经济药用植物资源的可持续利用和管理提供重要见解。.
ནང་དོན་གནད་བསྡུས
གོ་ལ་ཧྲིལ་བོའི་ཁྱབ་ཁོངས་སུ་ཀྲུང་ལུགས་གསོ་རིག་སྨན་རྩྭའི་དགོས་མཁོ་མགྱོགས་མྱུར་ངང་འཕར་བ་དེས་སྨན་རྩྭའི་རིགས་འཚོལ་སྡུད་ཀྱི་ལག་ལེན་རྒྱུན་མཐུན་མི་ཐུབ་པར་ཤུགས་རྐྱེན་ཐེབས་པ་མྱུར་ཞིང་མིག་སྔར་འཚོལ་སྡུད་མཁན་གྱིས་སྨན་དུ་སྤྱོད་པའི་སྐྱེ་དངོས་འཚོལ་བསྡུའི་དགའ་ཕྱོགས་དེས་རྒྱུན་མཐུད་བེད་སྤྱོད་དོ་དམ་སྐོར་ལ་ཤུགས་རྐྱེན་ཅི་ལྟར་ཐེབས་ཀྱིན་པའི་སྐོར་རྒྱུས་ལོན་བྱས་པ་སྔར་བཞིན་ཉུང་། རྩོམ་འདིར་རྒྱུན་མཐུད་བེད་སྤྱོད་དོ་དམ་ལ་གལ་འགངས་ཤིན་ཏུ་ཆེ་བའི་གསར་རྟོགས་གསུམ་ཡོད་པ་སྟེ། (༡) ས་གནས་འདིའི་མི་རྣམས་ལ་གདམ་ག་གཞན་ཡོད་པའི་སྐབས་སུ་སྐྱེ་དངོས་འཚོལ་སྡུད་ཀྱི་བྱ་བར་མི་དགའ་བར་མ་ཟད། གལ་སྲིད་འཚོལ་སྡུད་ཀྱི་བྱ་བ་བྱེད་དགོས་ཀྱང་མི་རྣམས་མེ་ཏོག་དང་འབྲས་བུ་འཚོལ་སྡུད་བྱས་ཆོག་པའི་སྐྱེ་དངོས་འཚོལ་སྡུད་ལ་དགའ་བ་ལས་རྩད་པའི་རིགས་བརྐོ་བཏུ་བྱེད་དགོས་པའི་སྐྱེ་དངོས་འཚོལ་སྡུད་བྱ་བར་མི་དགའ། ལག་ཆའི་སྐོར་ནས་ཀྱང་བོངས་ཆེ་བའི་ལྕགས་རིགས་ལག་ཆ་བཀོལ་བ་ལས་སྲོལ་རྒྱུན་གྱི་ཤིང་བཟོས་ལག་ཆ་བེད་སྤྱོད་བྱེད་པར་དགའ། (༢)སྡེ་གཞུང་གི་གོམས་སྲོལ་བརྩི་སྲུང་གི་གནས་ཚུལ་དང་སྐྱེ་ཁམས་ལྟ་བ། སྐྱེ་དངོས་ཀྱི་གང་མཁོ་བའི་ཆ་ཤས་དང་ཡོང་འབབ་བཅས་ཀྱིས་འཚོལ་སྡུད་མཁན་གྱི་དགའ་ཕྱོགས་ལ་ཤུགས་རྐྱེན་ཐེབས་ཀྱིན་ཡོད་པར་མ་ཟད།འཚོལ་སྡུད་མཁན་གྱི་འཚོ་ཐབས་ཀྱི་འགྱུར་བས་དེར་ཤུགས་རྐྱེན་ཐེབས་པ་ཆེས་ཟབ་ཀྱང་གནས་ཚུལ་གཞན་ལ་ཤུགས་རྐྱེན་ཐེབས་པ་མངོན་གསལ་མིན། (༣)ཞིབ་འཇུག་འདིར་ངོ་བོ་མི་འདྲ་བའི་འཚོལ་སྡུད་བྱེད་མཁན་རིགས་གསུམ་ཡོད་པ་གསལ་བོར་བསྟན་ཡོད་ཅིང་བྱེ་ཏུ་བཤད་ན། ༦༠%ལས་བརྒལ་བའི་འཚོལ་སྡུད་མཁན་ལ་རྒྱུན་མཐུད་བྱེད་ཕྱོགས་ཀྱི་སྐོར་ལ་མོས་པ་མངོན་གསལ་དོད་པོ་ཡོད་ཅིང་གཞན་པའི་རིགས་དེར་རྒྱུན་མཐུད་འཚོལ་སྡུད་ཀྱི་སྐོར་ལ་མོས་པ་མེད། མདོར་བསྡུས་ནས་བཤད་ན། རྩོམ་འདིར་གནས་འདིའི་མི་རྣམས་ཀྱི་སྨན་རྩྭའི་རིགས་གང་ཞིག་འཚོལ་སྡུད་བྱ་བའི་དགའ་ཕྱོགས་ལ་ཤུགས་རྐྱེན་ཐེབས་པའི་རྒྱུ་རྐྱེན་དང་འཚོལ་སྡུད་ཀྱི་ངོ་བོ་མི་འདྲ་བའི་རང་བཞིན་བཅས་གསལ་བོར་བཏོན་ནས་འབྱུང་འགྱུར་གྱི་དུས་དུ་མཚོ་བོད་མཐོ་སྒང་ས་ཁུལ་དང་ཐོན་ཁུངས་གཞན་ཀྱི་རིགས་ཁྱབ་པའི་ས་ཁུལ་དཔལ་འབྱོར་གྱི་སྨན་བཀོལ་སྐྱེ་དངོས་ཐོན་ཁུངས་རྒྱུན་མཐུད་བེད་སྤྱོད་དང་དོ་དམ་བྱ་རྒྱུའི་སྐོར་ལ་ལྟ་ཚུལ་གལ་ཆེན་འདོན་པ་དམིགས་སུ་བཟུང་ཡོད།.
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