Thousands of households in coastal Madagascar rely on locally manufactured pitcher-pump systems to provide water for drinking, cooking, and household use. These pumps typically include components made from lead (Pb). In this study, concentrations of Pb in water were monitored at 18 household pitcher pumps in the city of Tamatave over three sampling campaigns. Concentrations of Pb frequently exceeded the World Health Organization's provisional guideline for drinking water of 10 μg/L. Under first-draw conditions (i.e., after a pump had been inactive for 1 h), 67% of samples analyzed were in excess of 10 μg/L Pb, with a median concentration of 13 μg/L. However, flushing the pump systems before collecting water resulted in a statistically significant (p < 0.0001) decrease in Pb concentrations: 35% of samples collected after flushing exceeded 10 μg/L, with a median concentration of 9 μg/L. Based on measured Pb concentrations, a biokinetic model estimates that anywhere from 15% to 70% of children living in households with pitcher pumps may be at risk for elevated blood lead levels (>5 μg/dL). Measured Pb concentrations in water were not correlated at statistically significant levels with pump-system age, well depth, system manufacturer, or season of sample collection; only the contact time (i.e., flushed or first-draw condition) was observed to correlate significantly with Pb concentrations. In two of the 18 systems, Pb valve weights were replaced with iron, which decreased the observed Pb concentrations in the water by 57-89% in one pump and by 89-96% in the other. Both systems produced samples exclusively below 10 μg/L after substitution. Therefore, relatively straightforward operational changes on the part of the pump-system manufacturers and pump users might reduce Pb exposure, thereby helping to ensure the continued sustainability of pitcher pumps in Madagascar.

The etiology of increased prevalence of migraine in our study is unclear. Whether this is due to increased awareness of headache disorders, a consequence of contact exposure, or a predisposition for migraine development in this age group remains unclear. Further studies are indicated.

No abstract

OBJECTIVE: To determine whether achievement of body mass index (BMI)-specific weight gain recommendations is associated with a reduced risk of preterm birth (PTB) and improved neonatal outcomes among twin gestations. STUDY DESIGN: A retrospective cohort study of twin gestations delivered at the Medical University of South Carolina from 2000-2010. 588 women who delivered 24 weeks gestation in all prepregnancy BMI categories were included. Women with major fetal anomalies, fetal aneuploidy, twin-twin transfusion syndrome, cotwin fetal demise, and incomplete prenatal weight records were excluded. BMI-specific weight gain recommendations derived from Luke et al, J Reprod Med, 2003 were applied to each woman based on pre-pregnancy BMI. Women were assigned the designation of achieved or underachieved based on total weight gain and gestational age at delivery. Maternal and neonatal outcomes were compared between the groups. Our sample provides 80% power to detect a 50% difference in the rate of PTB < 32 weeks (p<0.05). RESULTS: BMI-specific weight gain goals were achieved by 49.3 % of women. The achieved group had a 2.5 fold reduction in the rate of preterm birth < 32 weeks (13 vs 34%). African Americans, women with an underweight pre-pregnancy BMI and women with a lower number of prenatal visits were significantly less likely to achieve recommended weight gain goals (Table 1). Women who achieved weight gain recommendations were significantly less likely to deliver any twin with a birth weight less than the tenth percentile for gestational age (larger twin, 0.3 vs 4.0 %, smaller twin 10.3 vs 21.5%). Composite neonatal morbidity, days on the respirator, length of hospital stay and rate of neonatal intensive care unit admission were significantly decreased in the achieved group. CONCLUSION: Achievement of BMI specific weight gain recommendations can decrease the incidence of preterm birth < 32 weeks and improve neonatal outcomes in twin gestations.