Weight loss before conception: A systematic literature review.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageThe prevalence of overweight and obesity in women has increased during the last decades. This is a serious concern since a high BMI before conception is an independent risk factor for many adverse outcomes of pregnancy. Therefore, dietary counseling, intended to stimulate weight loss in overweight and obese women prior to conception has recently been recommended. However, dieting with the purpose to lose weight may involve health risks for mother and offspring. We conducted a systematic literature review to identify papers investigating the effects of weight loss due to dietary interventions before conception. The objective of this study is to assess the effect of weight loss prior to conception in overweight or obese women on a number of health-related outcomes in mother and offspring using studies published between January 2000 and December 2011. Our first literature search produced 486 citations and, based on predefined eligibility criteria, 58 were selected and ordered in full text. Two group members read each paper. Fifteen studies were selected for quality assessment and two of them were considered appropriate for inclusion in evidence tables. A complementary search identified 168 citations with four papers being ordered in full text. The two selected studies provided data for overweight and obese women. One showed a positive effect of weight loss before pregnancy on the risk of gestational diabetes and one demonstrated a reduced risk for large-for-gestational-age infants in women with a BMI above 25 who lost weight before pregnancy. No study investigated the effect of weight loss due to a dietary intervention before conception. There is a lack of studies on overweight and obese women investigating the effect of dietary-induced weight loss prior to conception on health-related variables in mother and offspring. Such studies are probably lacking since they are difficult to conduct. Therefore, alternative strategies to control the body weight of girls and women of reproductive age are needed

Journal Staff

The prevalence of overweight and obesity in women has increased during the last decades. This is a serious concern since a high BMI before conception is an independent risk factor for many adverse outcomes of pregnancy. Therefore, dietary counseling, intended to stimulate weight loss in overweight and obese women prior to conception has recently been recommended. However, dieting with the purpose to lose weight may involve health risks for mother and offspring. We conducted a systematic literature review to identify papers investigating the effects of weight loss due to dietary interventions before conception. The objective of this study is to assess the effect of weight loss prior to conception in overweight or obese women on a number of health-related outcomes in mother and offspring using studies published between January 2000 and December 2011. Our first literature search produced 486 citations and, based on predefined eligibility criteria, 58 were selected and ordered in full text. Two group members read each paper. Fifteen studies were selected for quality assessment and two of them were considered appropriate for inclusion in evidence tables. A complementary search identified 168 citations with four papers being ordered in full text. The two selected studies provided data for overweight and obese women. One showed a positive effect of weight loss before pregnancy on the risk of gestational diabetes and one demonstrated a reduced risk for large-for-gestational-age infants in women with a BMI above 25 who lost weight before pregnancy. No study investigated the effect of weight loss due to a dietary intervention before conception. There is a lack of studies on overweight and obese women investigating the effect of dietary-induced weight loss prior to conception on health-related variables in mother and offspring. Such studies are probably lacking since they are difficult to conduct. Therefore, alternative strategies to control the body weight of girls and women of reproductive age are needed

Pay for performance: an analysis of the context of implementation in a pilot project in Tanzania.

BACKGROUND: Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets. METHOD: 40 in-depth interviews and four focus group discussions were undertaken with health workers, and regional, district and facility managers. Data was collected on work environment characteristics and staff attitudes towards work in the first phase of the implementation of the pilot. A survey of 75 facilities and 101 health workers were carried out to examine facility resourcing, and health worker employment conditions and job satisfaction. RESULTS: Five contextual factors which affect the implementation of P4P were identified by health workers: salary and employment benefits; resource availability, including staff, medicines and functioning equipment; supervision; facility access to utilities; and community preferences. The results suggest that it is important to consider contextual issues when implementing pay for performance schemes in low income settings. It highlights the importance of basic infrastructures being in place, a minimum number of staff with appropriate education and skills as well as sufficient resources before implementing pay for performance. CONCLUSION: Health professionals working within a pay for performance scheme in Tanzania were concerned about challenges related to shortages of resources, limited supplies and unfavourable community preferences. The P4P scheme may provide the incentive and means to address certain constraints, in so far as they are within the control of providers and managers, however, other constraints will be harder to address

The fallacy of the equity-efficiency trade off: rethinking the efficient health system

In the health systems literature one can see discussions about the trade off between the equity achievable by the system and its efficiency. Essentially it is argued that as greater health equity is achieved, so the level of efficiency will diminish. This argument is borrowed from economics literature on market efficiency. In the application of the economic argument to health, however, serious errors have been made, because it is quite reasonable to talk of both health equity being a desirable output of a health system, and the efficient production of that output. In this article we discuss notions of efficiency, and the equity-efficiency trade off, before considering the implications of this for health systems

Physical and cognitive impact following SARS-CoV-2 infection in a large population-based case-control study

© 2023. The Author(s).BACKGROUND: Persistent symptoms are common after SARS-CoV-2 infection but correlation with objective measures is unclear. METHODS: We invited all 3098 adults who tested SARS-CoV-2 positive in Iceland before October 2020 to the deCODE Health Study. We compared multiple symptoms and physical measures between 1706 Icelanders with confirmed prior infection (cases) who participated, and 619 contemporary and 13,779 historical controls. Cases participated in the study 5-18 months after infection. RESULTS: Here we report that 41 of 88 symptoms are associated with prior infection, most significantly disturbed smell and taste, memory disturbance, and dyspnea. Measured objectively, cases had poorer smell and taste results, less grip strength, and poorer memory recall. Differences in grip strength and memory recall were small. No other objective measure associated with prior infection including heart rate, blood pressure, postural orthostatic tachycardia, oxygen saturation, exercise tolerance, hearing, and traditional inflammatory, cardiac, liver, and kidney blood biomarkers. There was no evidence of more anxiety or depression among cases. We estimate the prevalence of long Covid to be 7% at a median of 8 months after infection. CONCLUSIONS: We confirm that diverse symptoms are common months after SARS-CoV-2 infection but find few differences between cases and controls in objective parameters measured. These discrepancies between symptoms and physical measures suggest a more complicated contribution to symptoms related to prior infection than is captured with conventional tests. Traditional clinical assessment is not expected to be particularly informative in relating symptoms to a past SARS-CoV-2 infection.Peer reviewe

A health system in economic crises: A case study from Iceland

Daniel Reidpath - ORCID: 0000-0002-8796-0420 https://orcid.org/0000-0002-8796-0420Item is not available in this repository.Background: There has been a lack of systematic inquiry into how governments respond during times of crises, how well these responses comply with good governance, and how they affect health systems. The aim of this study was to analyse the reactions of the Icelandic health system during the first 7 months of the economic crisis in 2008. Methods: The grounded theory approach was used in data sampling, collection, and data analysis. Secondary data were collected from parliamentary documents, news, and health discussions in two of the largest newspapers in Iceland. Primary data were collected through interviews with key stakeholders in the health sector. Atlas.ti. 5.2 was used to analyse the data. Results: The health sector’s first response to the crisis was to close and merge wards on hospitals as well as making structural changes to reduce the overhead costs in healthcare institutions. The Minister of Health attempted to introduce radical changes but because of failures in good governance practices, such as a lack of transparency and fair participation together with a lack of supporting documents, the proposed changes were not executed. Conclusions: Economic crises are a critical test of health systems’ resilience. The manner in which governance practices, together with strong stewardship, influence the ability of the health system to adapt to changes and reorganise without causing stress, confusion, or anger and without changing its basic structure and function are important, and open to robust evaluation.https://doi.org/10.1177/140349481247003841pubpub

Does milk and dairy consumption during pregnancy influence fetal growth and infant birthweight? A systematic literature review Does milk and dairy consumption during pregnancy influence fetal growth and infant birthweight? A systematic literature review

Abstract It is increasingly acknowledged that the maternal diet influences fetal development and health of the child. Milk and milk products contribute essential nutrients and bioactive substances; they are of ample supply and have a long tradition in Nordic countries. To revise and update dietary guidelines for pregnant women valid in Nordic countries, the Pregnancy and Lactation expert group within the NNR5 project identified a need to systematically review recent scientific data on infant growth measures and maternal milk consumption. The objective of this study was to assess the influence of milk and dairy consumption during pregnancy on fetal growth through a systematic review of studies published between January 2000 and December 2011. A literature search was run in June 2011. Two authors independently selected studies for inclusion from the 495 abstracts according to predefined eligibility criteria. A complementary search in January 2012 revealed 64 additional abstracts published during the period June to December 2011, among them one study of interest previously identified. Of the 33 studies extracted, eight were relevant research papers. Five were prospective cohort studies (including a retrospective chart review), one was a caseÁcontrol study, and two were retrospective cohort studies. For fetal length or infant birth length, three studies reported no association and two reported positive associations with milk or dairy consumption. For birthweight related outcomes, two studies reported no associations, and four studies reported positive associations with milk and/or dairy consumption. There was large heterogeneity in exposure range and effect size between studies. A beneficial fetal growth-increase was most pronounced for increasing maternal milk intake in the lower end of the consumption range. Evidence from prospective cohort studies is limited but suggestive that moderate milk consumption relative to none or very low intake, is positively associated with fetal growth and infant birthweight in healthy, Western populations