Browsing by Author "Rao, Deepa"
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Item Open Access Evaluation of the association between maternal smoking, childhood obesity, and metabolic disorders: a national toxicology program workshop review.(Environmental health perspectives, 2013-02) Behl, Mamta; Rao, Deepa; Aagaard, Kjersti; Davidson, Terry L; Levin, Edward D; Slotkin, Theodore A; Srinivasan, Supriya; Wallinga, David; White, Morris F; Walker, Vickie R; Thayer, Kristina A; Holloway, Alison CBackground
An emerging literature suggests that environmental chemicals may play a role in the development of childhood obesity and metabolic disorders, especially when exposure occurs early in life.Objective
Here we assess the association between these health outcomes and exposure to maternal smoking during pregnancy as part of a broader effort to develop a research agenda to better understand the role of environmental chemicals as potential risk factors for obesity and metabolic disorders.Methods
PubMed was searched up to 8 March 2012 for epidemiological and experimental animal studies related to maternal smoking or nicotine exposure during pregnancy and childhood obesity or metabolic disorders at any age. A total of 101 studies-83 in humans and 18 in animals-were identified as the primary literature.Discussion
Current epidemiological data support a positive association between maternal smoking and increased risk of obesity or overweight in offspring. The data strongly suggest a causal relation, although the possibility that the association is attributable to unmeasured residual confounding cannot be completely ruled out. This conclusion is supported by findings from laboratory animals exposed to nicotine during development. The existing literature on human exposures does not support an association between maternal smoking during pregnancy and type 1 diabetes in offspring. Too few human studies have assessed outcomes related to type 2 diabetes or metabolic syndrome to reach conclusions based on patterns of findings. There may be a number of mechanistic pathways important for the development of aberrant metabolic outcomes following perinatal exposure to cigarette smoke, which remain largely unexplored.Conclusions
From a toxicological perspective, the linkages between maternal smoking during pregnancy and childhood overweight/obesity provide proof-of-concept of how early-life exposure to an environmental toxicant can be a risk factor for childhood obesity.Item Open Access Outpatient Mental Health Services in Mozambique: Use and Treatments.(Psychiatr Serv, 2016-06-01) Wagenaar, Bradley H; Cumbe, Vasco; Raunig-Berhó, Manuela; Rao, Deepa; Kohrt, Brandon A; Stergachis, Andy; Napúa, Manuel; Sherr, KennethTo describe current outpatient mental health service use and treatments in Mozambique, the authors reviewed registry entries for 2,071 outpatient psychiatric visits at the Beira Central Hospital in Sofala Province from January 2012 to September 2014. Service use was most common for schizophrenia, followed by epilepsy, delirium, and organic behavioral disorders. Only 3% of consultations for schizophrenia were first-visit patients. Treatment seeking among women was more likely for mood and neurotic disorders and less likely for substance use disorders and epilepsy. First-generation antipsychotics, most often paired with promethazine, dominated treatment regimens. Evidence-based reforms are needed to improve identification of mood disorders and broaden care beyond severe mental disorders.