The year 2022 marked a pivotal shift in abortion rights in the United States. In its ruling on Dobbs vJackson Women's Health Organization, the Supreme Court overturned the constitutional guarantee to ...abortion established in Roe v Wade} In the wake of that decision, the need for temporary medical housing has surged, as individuals are now compelled to journey considerable distances to "access states" where abortion remains legal. These individuals often need overnight accommodations to access abortion care.Traveling for abortion care is not a new phenomenon, but, since Dobbs, additional tens of thousands of Americans have been forced to leave their home state to obtain abortion care.2,3 Veritably, individuals forced to travel for abortion care are faced with unique barriers to health care access, and the distances individuals are traveling are significant. In Texas, for example, progressively more restrictive bans have impacted the average forced travel distance to the nearest abortion clinic, and this is further compounded because of neighboring states restricting abortion access. Before the Supreme Court ruling, Texans seeking abortion care traveled an average of 12 miles for care. Now, as Texas and other states have instituted abortion bans, individuals need to reach facilities in often far-reaching access states, increasing the average distance to 498.78 miles and average travel time to more than seven hours (https://bit.ly/46yvfbx).4Because of this, the need to secure housing for abortion care has amplified considerably. Procedures previously within a few hours' drive may now require overnight stays or even extend over multiple days in unfamiliar cities.5 This often involves securing a hotel or comparable accommodations, a process fraught with its own logistical and financial challenges, such as identity requirements, credit card usage, and age restrictions. Furthermore, some clinics require their patients to remain nearby during their care, which adds additional logistical complexity. This can pose an overwhelming burden for many individuals, highlighting housing support as an essential social and practical need.
High Body Mass Index (BMI) and gestational weight gain (GWG) affect an increasing number of pregnancies. The Institute of Medicine (IOM) has issued recommendations on the optimal GWG for women ...according to their pre-pregnancy BMI (healthy, overweight or obese). It has been shown that pregnant women rarely met the recommendations; however, it is unclear by how much. Previous studies also adjusted the analyses for various women's characteristics making their comparison challenging.
We analysed individual participant data (IPD) of healthy women with a singleton pregnancy and a BMI of 18.5 kg/m
or more from the control arms of 36 randomised trials (16 countries). Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were used to describe the association between GWG outside (above or below) the IOM recommendations (2009) and risks of caesarean section, preterm birth, and large or small for gestational age (LGA or SGA) infants. The association was examined overall, within the BMI categories and by quartile of GWG departure from the IOM recommendations. We obtained aOR using mixed-effects logistic regression, accounting for the within-study clustering and a priori identified characteristics.
Out of 4429 women (from 33 trials) meeting the inclusion criteria, two thirds gained weight outside the IOM recommendations (1646 above; 1291 below). The median GWG outside the IOM recommendations was 3.1 kg above and 2.7 kg below. In comparison to GWG within the IOM recommendations, GWG above was associated with increased odds of caesarean section (aOR 1.50; 95%CI 1.25, 1.80), LGA (2.00; 1.58, 2.54), and reduced odds of SGA (0.66; 0.50, 0.87); no significant effect on preterm birth was detected. The relationship between GWG below the IOM recommendation and caesarean section or LGA was inconclusive; however, the odds of preterm birth (1.94; 1.31, 2.28) and SGA (1.52; 1.18, 1.96) were increased.
Consistently with previous findings, adherence to the IOM recommendations seem to help achieve better pregnancy outcomes. Nevertheless, even in the context of clinical trials, women find it difficult to adhere to them. Further research should focus on identifying ways of achieving a healthier GWG as defined by the IOM recommendations.
Context: Interventions targeting maternal obesity are a healthcare and public health priority. Objective: The objective of this review was to evaluate the adequacy and effectiveness of the ...methodological designs implemented in dietary intervention trials for obesity in pregnancy. Data Sources: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. Study Selection: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. Data Synthesis: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. Conclusion: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice.
Multi-year nitrogen (N) and phosphorus (P) budgets were developed for the Patuxent River estuary, a seasonally stratified and moderately eutrophic tributary of Chesapeake Bay. Major inputs (point, ...diffuse, septic, and direct atmospheric) were measured for 13 years during which, large reductions in P and then lesser reductions in N-loading occurred due to wastewater treatment plant improvements. Internal nutrient losses (denitrification and long-term burial of particulate N and P) were measured in tidal marshes and sub-tidal sediments throughout the estuary as were nutrient storage in the water column, sediments, and biota. Nutrient transport between the oligohaline and mesohaline zones and between the Patuxent and Chesapeake Bay was estimated using a salt and water balance model. Several major nutrient recycling terms were directly and indirectly evaluated and compared to new N and P inputs on seasonal and annual time-scales. Major findings included: (1) average terrestrial and atmospheric inputs of N and P were very close to the sum of internal losses plus export, suggesting that dominant processes are captured in these budgets; (2) both N and P export were a small fraction (13% and 28%, respectively) of inputs, about half of that expected for N based on water residence times, and almost all exported N and P were in organic forms; (3) the tidal marsh-oligohaline estuary, which by area comprised ~27% of the full estuarine system, removed about 46% and 74% of total annual upland N and P inputs, respectively; (4) recycled N and P were much larger sources of inorganic nutrients than new inputs during warm seasons and were similar in magnitude even during cold seasons; (5) there was clear evidence that major estuarine processes responded rapidly to inter-annual nutrient input variations; (6) historical nutrient input data and nutrient budget data from drought periods indicated that diffuse nutrient sources were dominant and that N loads need to be reduced by about 50% to restore water quality conditions to pre-eutrophic levels.
We examined stressors that have led to profound ecological changes in the Lake Ontario ecosystem and its fish community since 1970. The most notable changes have been reductions in phosphorus ...loading, invasion by Dreissena spp., fisheries management through stocking of exotic salmonids and control of sea lamprey (Petromyzon marinus), and fish harvest by anglers and double-crested cormorants (Phalacrocorax auritus). The response to these stressors has led to (i) declines in both algal photosynthesis and epilimnetic zooplankton production, (ii) decreases in alewife (Alosa pseudoharengus) abundance, (iii) declines in native Diporeia and lake whitefish (Coregonus clupeaformis), (iv) behavioral shifts in alewife spatial distribution benefitting native lake trout (Salvelinus namaycush), threespine stickleback (Gasterosteus aculeatus), and emerald shiner (Notropis atherinoides) populations, (v) dramatic increases in water clarity, (vi) predation impacts by cormorants on select fish species, and (vii) lake trout recruitment bottlenecks associated with alewife-induced thiamine deficiency. We expect stressor responses associated with anthropogenic forces like exotic species invasions and global climate warming to continue to impact the Lake Ontario ecosystem in the future and recommend continuous long-term ecological studies to enhance scientific understanding and management of this important resource.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Five large rivers that discharge on the western North Atlantic continental shelf carry about 45% of the nitrogen (N) and 70% of the phosphorus (P) that others estimate to be the total flux of these ...elements from the entire North Atlantic watershed, including North, Central and South America, Europe, and Northwest Africa. We estimate that 61· 109 moles y-1 of N and 20· 109 moles y-1 of P from the large rivers are buried with sediments in their deltas, and that an equal amount of N and P from the large rivers is lost to the shelf through burial of river sediments that are deposited directly on the continental slope. The effective transport of active N and P from land to the shelf through the very large rivers is thus reduced to 292· 109 moles y-1 of N and 13· 109 moles y-1 of P. The remaining riverine fluxes from land must pass through estuaries. An analysis of annual total N and total P budgets for various estuaries around the North Atlantic revealed that the net fractional transport of these nutrients through estuaries to the continental shelf is inversely correlated with the log mean residence time of water in the system. This is consistent with numerous observations of nutrient retention and loss in temperate lakes. Denitrification is the major process responsible for removing N in most estuaries, and the fraction of total N input that is denitrified appears to be directly proportional to the log mean water residence time. In general, we estimate that estuarine processes retain and remove 30-65% of the total N and 10-55% of the total P that would otherwise pass into the coastal ocean. The resulting transport through estuaries to the shelf amounts to 172-335· 109 moles y-1 of N and 11-9· 109 moles y-1 of P. These values are similar to the effective contribution from the large rivers that discharge directly on the shelf. For the North Atlantic shelf as a whole, N fluxes from major rivers and estuaries exceed atmospheric deposition by a factor of 3.5-4.7, but this varies widely among regions of the shelf. For example, on the U.S. Atlantic shelf and on the northwest European shelf, atmospheric deposition of N may exceed estuarine exports. Denitrification in shelf sediments exceeds the combined N input from land and atmosphere by a factor of 1.4-2.2. This deficit must be met by a flux of N from the deeper ocean. Burial of organic matter fixed on the shelf removes only a small fraction of the total N and P input (2-12% of N from land and atmosphere; 1-17% of P), but it may be a significant loss for P in the North Sea and some other regions. The removal of N and P in fisheries landings is very small. The gross exchange of N and P between the shelf and the open ocean is much larger than inputs from land and, for the North Atlantic shelf as a whole, it may be much larger than the N and P removed through denitrification, burial, and fisheries. Overall, the North Atlantic continental shelf appears to remove some 700-950· 109 moles of N each year from the deep ocean and to transport somewhere between 18 and 30· 109 moles of P to the open sea. If the N and P associated with riverine sediments deposited on the continental slope are included in the total balance, the net flux of N to the shelf is reduced by 60· 109 moles y-1 and the P flux to the ocean is increased by 20· 109 moles y-1. These conclusions are quite tentative, however, because of large uncertainties in our estimates of some important terms in the shelf mass balance.
This study aimed to explore the preferences, experiences and restraint practices of Australian parents travelling with their children in rideshare vehicles. Six hundred and thirty-one participants ...completed an online survey (M = 39.2 years, SD = 10.5, Range = 18.0–70.0 years; Female: 63.4%). Most participants (59.1%) reported that they had not travelled in a rideshare vehicle with their youngest child (M = 7.2 years, SD = 5.2, Range = 0.0–17.0 years; Male: 54.2%). Participants who reported that they have travelled with their youngest child in a rideshare vehicle tended to: be younger, identify as male, have completed an Undergraduate or Postgraduate degree, reside in the Australian Capital Territory, earning a higher yearly household income, and were involved in an at-fault crash in the past two years. In addition, these participants were: less likely to have a ‘younger’ youngest child, less likely to ‘always’ wear a seatbelt while travelling in their private motor vehicle, and also less likely to ‘always’ restrain their child in an appropriate restraint while travelling in their private motor vehicle. Prohibitive reasons for not travelling in a rideshare vehicle included: cost (29.3%), concerns over driver safety (27.5%), concerns over travelling with children in a rideshare service (24.8%), or inconvenience (24.3%). Participants who reported that they had travelled in a rideshare vehicle with their youngest child reported lower rates of appropriate restraint use within the rideshare vehicle (57.3%) than when travelling in their private motor vehicle (85.6%). Reasons associated with inappropriate restraint use within the rideshare vehicle included: unavailability of a child restraint (39.6%), travelling a short distance (33.0%), were not required to use one in this situation (33.0%), or the parent did not have a restraint with them (26.4%). Given the increasing popularity of rideshare services in Australia, and globally, the urgent adaption of rideshare-specific policy, legislation, education, and design in relation to child restraint requirements is needed to ensure the safety of child occupants.
The important questions about agriculture, climate, and sustainability have become increasingly complex and require a coordinated, multifaceted approach for developing new knowledge and ...understanding. A multistate, transdisciplinary project was begun in 2011 to study the potential for both mitigation and adaptation of corn-based cropping systems to climate variations. The team is measuring the baseline as well as change of the system’s carbon (C), nitrogen (N), and water footprints, crop productivity, and pest pressure in response to existing and novel production practices. Nine states and 11 institutions are participating in the project, necessitating a well thought out approach to coordinating field data collection procedures at 35 research sites. In addition, the collected data must be brought together in a way that can be stored and used by persons not originally involved in the data collection, necessitating robust procedures for linking metadata with the data and clearly delineated rules for use and publication of data from the overall project. In order to improve the ability to compare data across sites and begin to make inferences about soil and cropping system responses to climate across the region, detailed research protocols were developed to standardize the types of measurements taken and the specific details such as depth, time, method, numbers of samples, and minimum data set required from each site. This process required significant time, debate, and commitment of all the investigators involved with field data collection and was also informed by the data needed to run the simulation models and life cycle analyses. Although individual research teams are collecting additional measurements beyond those stated in the standardized protocols, the written protocols are used by the team for the base measurements to be compared across the region. A centralized database was constructed to meet the needs of current researchers on this project as well as for future use for data synthesis and modeling for agricultural, ecosystem, and climate sciences.
Diet- and physical activity-based interventions in pregnancy have the potential to alter maternal and child outcomes.
To assess whether or not the effects of diet and lifestyle interventions vary in ...subgroups of women, based on maternal body mass index (BMI), age, parity, Caucasian ethnicity and underlying medical condition(s), by undertaking an individual patient data (IPD) meta-analysis. We also evaluated the association of gestational weight gain (GWG) with adverse pregnancy outcomes and assessed the cost-effectiveness of the interventions.
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects and Health Technology Assessment database were searched from October 2013 to March 2015 (to update a previous search).
Researchers from the International Weight Management in Pregnancy Collaborative Network shared the primary data. For each intervention type and outcome, we performed a two-step IPD random-effects meta-analysis, for all women (except underweight) combined and for each subgroup of interest, to obtain summary estimates of effects and 95% confidence intervals (CIs), and synthesised the differences in effects between subgroups. In the first stage, we fitted a linear regression adjusted for baseline (for continuous outcomes) or a logistic regression model (for binary outcomes) in each study separately; estimates were combined across studies using random-effects meta-analysis models. We quantified the relationship between weight gain and complications, and undertook a decision-analytic model-based economic evaluation to assess the cost-effectiveness of the interventions.
Diet and lifestyle interventions reduced GWG by an average of 0.70 kg (95% CI -0.92 to -0.48 kg; 33 studies, 9320 women). The effects on composite maternal outcome summary odds ratio (OR) 0.90, 95% CI 0.79 to 1.03; 24 studies, 8852 women and composite fetal/neonatal outcome (summary OR 0.94, 95% CI 0.83 to 1.08; 18 studies, 7981 women) were not significant. The effect did not vary with baseline BMI, age, ethnicity, parity or underlying medical conditions for GWG, and composite maternal and fetal outcomes. Lifestyle interventions reduce Caesarean sections (OR 0.91, 95% CI 0.83 to 0.99), but not other individual maternal outcomes such as gestational diabetes mellitus (OR 0.89, 95% CI 0.72 to 1.10), pre-eclampsia or pregnancy-induced hypertension (OR 0.95, 95% CI 0.78 to 1.16) and preterm birth (OR 0.94, 95% CI 0.78 to 1.13). There was no significant effect on fetal outcomes. The interventions were not cost-effective. GWG, including adherence to the Institute of Medicine-recommended targets, was not associated with a reduction in complications. Predictors of GWG were maternal age (summary estimate -0.10 kg, 95% CI -0.14 to -0.06 kg) and multiparity (summary estimate -0.73 kg, 95% CI -1.24 to -0.23 kg).
The findings were limited by the lack of standardisation in the components of intervention, residual heterogeneity in effects across studies for most analyses and the unavailability of IPD in some studies.
Diet and lifestyle interventions in pregnancy are clinically effective in reducing GWG irrespective of risk factors, with no effects on composite maternal and fetal outcomes.
The differential effects of lifestyle interventions on individual pregnancy outcomes need evaluation.
This study is registered as PROSPERO CRD42013003804.
The National Institute for Health Research Health Technology Assessment programme.
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