Maternal age and risk of cesarean section in women with induced labor at term - a Nordic register-based study

Abstract Introduction Over the last decades, induction of labor has increased in many countries along with increasing maternal age. We assessed the effects of maternal age and labor induction on cesarean section at term among nulliparous and multiparous women without previous cesarean section. Material and methods We performed a retrospective national registry-based study from Denmark, Finland, Iceland, Norway and Sweden including 3 398 586 deliveries between 2000 and 2011. We investigated the impact of age on cesarean section among 196 220 nulliparous and 188 158 multiparous women whose labor was induced, had single cephalic presentation at term and no previous cesarean section. Confounders comprised country, time-period and gestational age. Results In nulliparous women with induced labor the rate of cesarean section increased from 14.0% in women less than 20 years of age to 39.9% in women 40 years and older. Compared to women aged 25-29 years, the corresponding relative risk were 0.60 (95% confidence interval (CI); 0.57 to 0.64) and 1.72 (95% CI; 1.66 to 1.79). In multiparous induced women the risk of cesarean section was 3.9% in women less than 20 years rising to 9.1% in women 40 years and older. Compared to women aged 25-29 years, the relative risk were 0.86 (95% CI; 0.54 to 1.37) and 1.98 (95% CI; 1.84 to 2.12), respectively. There were minimal confounding effects of country, time-period and gestational age on risk for cesarean section. Conclusions Advanced maternal age is associated with increased risk of cesarean section in women undergoing labor induction with a single cephalic presentation at term without a previous cesarean section. The absolute risk of cesarean section is 3-5 times higher across 5-year age groups in nulliparous relative to multiparous women having induced labor.Peer reviewe

Deep phenotyping of the unselected COPSAC2010 birth cohort study

BACKGROUND: We hypothesize that perinatal exposures, in particular the human microbiome and maternal nutrition during pregnancy, interact with the genetic predisposition to cause an abnormal immune modulation in early life towards a trajectory to chronic inflammatory diseases such as asthma and others. OBJECTIVE: The aim of this study is to explore these interactions by conducting a longitudinal study in an unselected cohort of pregnant women and their offspring with emphasis on deep clinical phenotyping, exposure assessment, and biobanking. Exposure assessments focus on the human microbiome. Nutritional intervention during pregnancy in randomized controlled trials are included in the study to prevent disease and to be able to establish causal relationships. METHODS: Pregnant women from eastern Denmark were invited during 2008–2010 to a novel unselected ‘COPSAC(2010)’ cohort. The women visited the clinic during pregnancy weeks 24 and 36. Their children were followed at the clinic with deep phenotyping and collection of biological samples at nine regular visits until the age of 3 and at acute symptoms. Randomized controlled trials of high‐dose vitamin D and fish oil supplements were conducted during pregnancy, and a trial of azithromycin for acute lung symptoms was conducted in the children with recurrent wheeze. RESULTS: Seven hundred and thirty‐eight mothers were recruited from week 24 of gestation, and 700 of their children were included in the birth cohort. The cohort has an over‐representation of atopic parents. The participant satisfaction was high and the adherence equally high with 685 children (98%) attending the 1 year clinic visit and 667 children (95%) attending the 2 year clinic visit. CONCLUSIONS: The COPSAC(2010) birth cohort study provides longitudinal clinical follow‐up with highly specific end‐points, exposure assessments, and biobanking. The cohort has a high adherence rate promising strong data to elucidate the interaction between genomics and the exposome in perinatal life leading to lifestyle‐related chronic inflammatory disorders such as asthma

Environmental Impact Assessment and Strategic Environmental Assessment in the UK after leaving the European Union

The United Kingdom has voted to leave the European Union and, until the terms of the ‘Brexit’ are negotiated, this has led to considerable uncertainty over the future practice of Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) in the UK. Here we show that multiple obligations exist outside the scope of the EU which mean that EIA and SEA will continue to be required in the long-term, but that their future compliance with the Directives remains unclear. We consider three scenarios for Brexit and present the implications of each; these are: signing up to the European Economic Area (EEA) Agreement; membership of the European Free Trade Association (EFTA), but not EEA, or negotiate a separate agreement. The implications of no longer being subjected to the obligations of the Directives under some scenarios are discussed and include opening the door for increasing diversity of application across the regions of the UK, and the probability of raised screening thresholds so as to reduce the burden of assessment on developers

Mordýr (Collembola) í túnum og úthaga á norðanverðu Íslandi

Surface-living invertebrates in grassland habitats were collected in pitfall traps for one year in three hayfields and three pastures in northern Iceland. Hayfields and pastures were on three different soil types; sand, silt and peat. Traps were renewed at weekly intervals during summer (six replicates) but at longer and variable intervals during winter (two replicates). Collembolans were counted and grouped to families or subclasses. During the summer season Collembola were most abundant in late summer and early autumn (second part of July to end of August) and Isotomidae and Symphypleona dominated. Onychiuridae and Entomobryidae culminated in spring, Hypogastruridae and Symphypleona in late summer and Istomidae in early autumn. During summer Collembolans dominated by Onychiuridae, Isotomidae and Entomobryidae were significantly more abundant in pastures than hayfields, indicating that hayfield cultivation (fertilization and mowing) disturbs the natural pasture habitat. Hypogastruridae and Symphypleona were not significantly more abundant in hayfields. Isotomidae and Symphypleona thrived significantly best in peat soil and Onychiuridae in silt soil. The number of collected Collembolans was about nine times higher during the summer than in the winter. During winter Entomobryidae were also more abundant in pastures than in hayfields and also more abundant than Hypogastruridae in hayfields. In soil samples collected in September four species dominated: the Hypogstruridae species Ceratophysella denticulata in hayfields on peat soil, the Onychiuridae species Protaphorura bicampata on silt soil and mainly in pastures, and the Isotomidae species Isotoma caerulea on peat soil. The fourth species, the Isotomidae Parisotoma notabilis, was not attracted by a specific environment.Hryggleysingjum sem lifa á jarðvegsyfirborði var safnað í eitt ár í fallgildrur í þremur túnum og þremur sambærilegum úthagaspildum á Norðurlandi. Túnin og beitilöndin voru á þrenns konar jarðvegi; sandi, mólendi og mýri. Fallgildrur voru tæmdar vikulega að sumri (sex endurtekningar) en með breytilegu og lengra millibili að vetri (tvær endurtekningar). Mordýr voru talin og flokkuð í ættir eða undirflokka. Heildarfjöldi mordýra varð mestur síðla sumars og að hausti (síðari hluti júlí til ágústloka) og mordýr af undirflokknum kúlumor (Symphypleona) og af ættinni stökkmor (Isotomidae) voru ríkjandi. Mordýr af pottamorsættinni (Onychiuridae) ásamt kengmori (Entomobryidae) náðu hámarki að vori en blámor (Hypogastruridae) og kúlumor síðla sumars og stökkmor snemma að hausti. Yfir sumartímann voru pottamor, stökkmor og kengmor marktækt algengari í úthaga en túnum, sem bendir til þess að ræktun (áburður og sláttur) trufli náttúrulegt búsvæði þessara mordýraætta. Blámor og kúlumor voru heldur algengari í túnum en úthaga. Stökkmor og kúlumor döfnuðu best í mýrlendi en pottamor í mólendi. Fjöldi stökkmora var um það bil níu sinnum meiri að sumri en vetri. Kengmor var einnig að vetri algengara í úthaga en túnum en blámor hins vegar í túnum. Í jarðvegssýnum sem safnað var í september voru fjórar mordýrategundir ríkjandi, Ceratophysella denticulata (blámor), Protaphorura bicampata (pottamor) í úthaga á mólendi og Isotoma caerulea (stökkmor) á mýrlendi. Fjórða algengasta tegundin, Parisotoma notabilis (stökkmor) virðist ekki laðast að neinum sérstökum jarðvegi eða meðferð

Methane formation in 10 Icelandic landfills

Með gildistöku reglugerðar nr. 738/2003 um urðun úrgangs var urðunarstöðum á Íslandi sem taka á móti lífrænum úrgangi skylt að safna hauggasi eftir 16. júlí 2009. Hauggas samanstendur að stærstum hluta af gróðurhúsalofttegundunum koldíoxíð og metan, en metan er um 21 sinnum öflugri gróðurhúsalofttegund en koldíoxíð. Markmiðið með þessari rannsókn var að meta hauggasmyndun í tíu urðunarstöðum á Íslandi sem hafa fengið undanþágu á gassöfnunarákvæði reglugerðar nr. 738/2003. Urðunarstaðirnir þjónusta frá 500 til 20.000 íbúa og urða samtals 40 þúsund tonn af úrgangi á ári. Mælingar á samsetningu hauggass, framkvæmdar þrisvar árið 2010, gefa til kynna að tæknilega sé mögulegt að safna hauggasinu sem myndast á sjö urðunarstöðum af tíu. Hermanir IPCC-líkansins sýna að möguleg metanmyndun í urðunarstöðum fyrir lítil bæjarfélög (1.500-20.000 íbúar) sé um 0.0032 m3/klst. á íbúa á ári. Einungis einn urðunarstaður í þessari rannsókn, þ.e. Akureyri, framleiðir nægilegt magn metans sem þarf til þess að safna því miðað við þýsk og finnsk söfnunarviðmið. Fyrir hina staðina er nauðsynlegt að skoða aðrar aðferðir við eyðingu metans, eins og t.d. oxun í yfirborðslagi.With adoption of the regulation nr.738/2003 on landfilling of waste in Iceland, collection of landfill gas is mandatory in landfills receiving organic waste after the 16th of July 2009. Landfill gas is composed mostly of the greenhouse gases carbon dioxide and methane. Methane is 21 times more effective as a greenhouse gas then carbon dioxide. The main goal of this research is to estimate the methane formation of landfill gas collection in 10 Icelandic landfills which were granted exemptions from gas collection. The landfills serve 500–20.000 people and landfill 40.000 tons of waste in total. Measurements of the composition of landfill gas in the summer 2010 indicate that gas collection is technically possible in 7 of the 10 landfills. Simulations with IPCC show that methane production in landfills serving 1500–20.000 people is in the range of 0.0032 m3/hour per capita per year. In this research only one landfill, at Akureyri, is estimated to produce the amount of methane necessary for gas collection according to german and Finnish guidelines. It is necessary to look at other methods to reduce methane emissions from the other landfills rather than to build up expensive gas collection