Summer 2012 Practicum Veliky Novgorod, Russia
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Transcript of Summer 2012 Practicum Veliky Novgorod, Russia
Summer 2012 PracticumVeliky Novgorod, Russia
Julie MoozaDepartment of Epidemiology, University of Massachusetts
Outline1. Veliky Novgorod: A Tour of Images• History • Sites• Portrait of Today• Maternity Clinic
2. Practicum Project: An Epidemiological Study• Introduction• Methods• Discussion
History
• Veliky Novgorod translates literally to “Great New City.”
• Originally populated by Scandinavians (Norse).
• Founded in the year 859.
1. Wooden Architecture Museum
2. Local Cathedrals
3. Novgorod Kremlin
Sites
Museum Vitoslavlitsy (wooden architecture museum)
Interior house
Exterior house Cathedral
Local cathedrals
Novgorod Kremlin St. Sephia’s Cathedral
Portrait of Today
Dormitory Around Town
Around Town
Maternity Clinic
Maternity clinic facilities
PRACTICUM PROJECTAn epidemiological study to assess the relationship
between alcohol consumption and smoking during pregnancy and low birth weight (LBW) in infants born
in Veliky Novgorod, Russia.
• Prevalence of LBW
• Morbidity and Mortality of LBW
• Established Risk Factors of LBW
• Physiology of Alcohol, Smoking, and LBW
INTRODUCTION
Prevalence
Russia
Year Prevalence (%)
1990 5.3
2001 6.3
2006 5.9
2007 6.0
Data from Index Mundi. (2011) Profiles of country statistics. Retrieved from www.indexmundi.com on October 26, 2011.
United States
Year Prevalence (%)
1990 7.0
1994 7.3
1998 7.4
2002 7.8
Morbidity
• LBW infants are at increased risk for developing:• Neurodevelopmental handicaps• Congenital anomalies• Lower respiratory tract conditions• Learning disabilities
• LBW infants are 3 times as likely as to have neurodevelopmental handicaps as normal birth weight infants.
Mortality
• During pregnancy, risk of neonatal death is 200 times greater for very low birth weight (VLBW) infants than for normal birth weight infants.
• During first 4 weeks of life, LBW infants are almost 40 times more likely to die than normal birth weight infants.
• During first year of life, LBW infants are 5 times more likely to die than normal birth weight infants.
Risk Factors
Demographic: Age, socioeconomic status, education level, race.
Medical (Predating Pregnancy): Parity, maternal BMI, select diseases, obstetric history, and genetic factors.
Medical (Current Pregnancy): Number of fetuses (singleton, twins, etc.), weight stability, and select diseases.
Health Care: Presence or absence of prenatal care.
Behavioral: Smoking, nutrition, alcohol and substance abuse.
Environmental: Toxic exposures, and high altitudes.
Developing Concepts: Physical and psychological stress, and select diseases.
Intrauterine Growth
Retardation (IUGR)
Physiology
Alcohol Ingestion
Smoke Inhalation
Low Birth Weight
Preterm Birth
Nicotine, Hydrogen Cyanide, Carbon Monoxide
Oxygen Supply is Depleted
EthanolAcetaldehyde
Nutrient Absorption is
Disrupted
• Study Design, Population, Sample Size
• Exposure Assessment
• Outcome Assessment
METHODS
• Study Design: Cross-sectional.
• Study Population: Mothers who gave birth in the maternity clinic between June 1, 2010 and June 1, 2011 in Veliky Novgorod, Russia.
• Sample Size: 84 completed questionnaires were collected from 100 distributed questionnaires.
• Questionnaire: An adaptation of the Centers for Disease Control’s Pregnancy Risk Assessment System (PRAMS).
• Adaptations to the Questionnaire:• Subtracted: Nutrition and health insurance questions.• Condensed: Physical and psychosocial questions.• Added: Two questions regarding medical conditions and
medications.
Exposure Assessment
• Self Report: Mothers reported birth weight on questionnaire.
• Clinical Chart Review: Considered the “gold standard” of collection methods.
Outcome Assessment
AND
• Limitations
• Strengths
DISCUSSION
Sample Size: 84 completed questionnaires.• Results will provide low statistical power.
Selection Bias: There was an 84% participation rate.• Mean differences in birth weight will be underestimated.
Misclassification of Exposure: Women were likely to report no drinking or smoking when in fact they had. • Mean differences in birth weight will be underestimated.
Limitations
Confounding Variables: First study to include this combination of covariates in the regression model.
Study Population: First study to examine this exposure-outcome relationship in Veliky Novgorod and (to my knowledge) the second study to examine this exposure-outcome relationship in Russia.
Strengths
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