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Special Edition

Socioeconomic Privation & Congenital Birth Defects – Cause or Coincidence?

1 Jun, 15 | by Kristy Ebanks

By Kristian Dye

This week I’m looking at two very sad cases of stillbirth in Cali, Colombia.

When we think of disease caused by social circumstance we often imagine non-communicable diseases or infectious diseases, usually where poor living conditions loom large in the aetiology.

When we consider the higher rates of genetic birth defects in socially disadvantaged populations we often express our dismay at what rotten luck it is that this happens to people who are also poor. Here, we miss a key to understanding these diseases. The circumstance of being socioeconomically deprived can provide the conditions necessary for defects of the type in these cases to occur.

Sirenomelia is a rare congenital defect with a prevalence rate of around 1 in every 100,000 birth, and 300 cases have been reported in the literature. The aetiology and pathophysiology of the defect is not well understood, but is thought to be related to vascular abnormality.

‘The vascular steal hypothesis suggests the existence of an anomalous vessel impeding proper blood flow to the caudal end of the embryo. One of the most important early findings in prenatal imaging is a SUA [single uterine artery] of abnormal origin, with SUA of vitelline origin being considered characteristic of sirenomelia.’

There are a number of known risk factors associated with sirenomelia, including maternal diabetes and exposure to teratogenic drugs (such as anti-convulsants or retinoids). Neither mother had abnormal glycaemic control, and neither had been exposed knowingly to teratogens. Incidence of sirenomelia appears to decrease with advancing maternal age – and both women were in the non-increased prevalence group. The only common risk factor between the women was their access to water. Both women relied upon a nearby river for their water – a river which is known to be contaminated with leachate from landfill.

‘During their normal daily activities they were exposed to the river that flows near their homes, where they would wash their clothes and perform personal hygiene activities.’

The contaminated water is known to affect changes in the fish population. The women lived less than 2km from one another. There is a large amount of literature which has observed a correlation between socio-economic status and increased incidence of congenital abnormality – and in particular between proximity to landfill and deformity. One study, of centers in the UK, found that the relative risk of non-chromosomal abnormalities increased by 40% between the most affluent quintile and the most deprived. Where the literature perhaps underestimates the effect at the level of the global population is that the majority of studies are based in the North America or Europe, where socioeconomic deprivation is less relative to the global standard, and where there is a great deal more environmental regulation than elsewhere in many other parts of the world.What is clear, however, is that we can’t think of socially determined health in simple terms of diseases that are transmitted within poor conditions, or are developed as a result of poor nutrition, education or living conditions. Children can be born with disability and disease as a result of the conditions their mothers live in.

1. http://casereports.bmj.com/content/2015/bcr-2014-207543.full?sid=a42f459e-cacf-4e28-b0ca-e50f05aef649
2. http://www.jneonatalsurg.com/documents/vol-1/pdf/jns-2012-1-2.pdf
3. http://m.aje.oxfordjournals.org/content/167/2/145.full.pdf
4. http://www.ncbi.nlm.nih.gov/pubmed/21689813
5. http://www.marchofdimes.org/materials/global-report-on-birth-defects-the-hidden-toll-of-dying-and-disabled-children-full-report.pdf Page 23
6. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)01352-X/fulltext
7. http://www.sciencedirect.com/science/article/pii/S0140673602075311
8. http://adc.bmj.com/content/82/5/349.full.pdf

Student Editor BMJ Case Reports

19 Feb, 15 | by Kristy Ebanks

BMJ Case Reports is looking for a medical student to work with us to enhance the journal for student authors and readers. BMJ Case Reports is an award winning online journal that publishes articles in all specialties – there are currently more than 10,000 published articles from 70 countries.

We want the Student Editor to identify the cases that are of most value for medical students and highlight these in our Blog – these will be the cases that have excellent learning points for students at all stages of their training and may be “textbook cases”.

You will also work on our newly created Global Health blog where where we feature case reports that discuss the social determinants of health and challenges (and potential solutions) to important Global Health problems. We are keen to develop this collection and to attract articles based on student electives.

We estimate that you will need to devote two to three hours per week to the role. You will have access to all the published articles and you may submit your own to be peer reviewed. You will be listed on our Editorial Board with a brief biography and we will support your attendance at events for medical students so you can promote BMJ Case Reports.

You can work remotely and you are welcome to visit us at BMA House and to attend any editorial meetings.

If you are interested in applying for the role please send your CV and ideas on how to improve the value of BMJ Case Reports for medical students to bmjcasereports@bmj.com before 31st March 2015. We welcome applications from students in any year.

5th Year Anniversary Special Edition

15 May, 14 | by Kristy Ebanks

In celebration of the BMJ Case Report’s 5th Birthday (late 2013) we have produced a Special Edition booklet

Have a look at these articles and, feel free to use them as a guideline for the kind of cases that we are interested in publishing.

Enjoy!!

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Click on the image to download the PDF

BMJ Case Reports: publishing, sharing and learning through experience

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