Maternal body mass index and cervical length among women with a history of spontaneous preterm birth†

Objectives: To evaluate whether women with a prior spontaneous preterm birth (SPTB) with a higher body mass index (BMI) have a lower risk of a shortened cervix in a subsequent pregnancy. Study Design: A secondary analysis of the Maternal-Fetal Medicine Units Network RCT of omega-3 fatty acid supplementation for recurrent SPTB prevention. All women had ≥1 prior SPTB <37 weeks, a singleton pregnancy, and initiated 17-alpha hydroxyprogesterone caproate(17-OHPC). The primary exposure was pre-pregnancy BMI. The primary outcome was the shortest transvaginal cervical length <30 mm. Results: Of the 356 women with a prior SPTB receiving 17-OHPC and a cervical length available, 108 (30%) were overweight and 103 (29%) obese; 12% had a cervical length <30 mm. Fewer overweight/obese women had a shortened cervix compared to normal-weight women (43 versus 57%; odds ratio: 0.47 [95%CI: 0.25–0.89]). After adjusting for maternal age, number of prior SPTBs, and tobacco use, overweight/obese women were less than half as likely to have a shortened cervix compared to normal-weight women (adjusted odds ratio: 0.46, 95%CI: 0.24–0.89). Conclusions: Overweight and obese women with a prior SPTB receiving 17-OHPC have longer cervical lengths compared to normal weight women, and this finding could explain a possible mechanism between the decreased rate of SPTB and larger BMI

Editing to Eulerian Graphs

We investigate the problem of modifying a graph into a connected graph in which the degree of each vertex satisfies a prescribed parity constraint. Let ea, ed and vd denote the operations edge addition, edge deletion and vertex deletion respectively. For any S subseteq {ea,ed,vd}, we define Connected Degree Parity Editing (S) (CDPE(S)) to be the problem that takes as input a graph G, an integer k and a function delta: V(G) -> {0,1}, and asks whether G can be modified into a connected graph H with d_H(v) = delta(v)(mod 2) for each v in V(H), using at most k operations from S. We prove that (*) if S={ea} or S={ea,ed}, then CDPE(S) can be solved in polynomial time; (*) if {vd} subseteq S subseteq {ea,ed,vd}, then CDPE(S) is NP-complete and W-hard when parameterized by k, even if delta = 0. Together with known results by Cai and Yang and by Cygan, Marx, Pilipczuk, Pilipczuk and Schlotter, our results completely classify the classical and parameterized complexity of the CDPE(S) problem for all S subseteq {ea,ed,vd}. We obtain the same classification for a natural variant of the cdpe(S) problem on directed graphs, where the target is a weakly connected digraph in which the difference between the in- and out-degree of every vertex equals a prescribed value. As an important implication of our results, we obtain polynomial-time algorithms for Eulerian Editing problem and its directed variant. To the best of our knowledge, the only other natural non-trivial graph class H for which the H-Editing problem is known to be polynomial-time solvable is the class of split graphs

Trends in opioid and psychotropic prescription in pregnancy in the united states from 2001 to 2015 in a privately insured population: A cross-sectional study

Background: Opioid and psychotropic prescriptions are common during pregnancy. Little is known about coprescriptions of both medications in this setting. Objective: To describe opioid prescription among women who are prescribed psychotropics compared with women who are not. Design: Cross-sectional study. Setting: U.S. commercial insurance beneficiaries from Market- Scan (2001 to 2015). Participants: Pregnant women at 22 weeks' gestation or greater who were insured continuously for 3 months or more before pregnancy through delivery. Measurements: Opioid prescription, dosage thresholds (morphine milligram equivalents [MME] of ≥50/day and ≥90/day), number of opioid agents (≥2), and duration (≥30 days) among those with and without prescription of psychotropics, from 2011 to 2015. Results: Among 958 980 pregnant women, 10% received opioids only, 6% psychotropics only, and 2% opioids with coprescription of psychotropics. Opioid prescription was higher among women prescribed psychotropics versus those who were not (26.5% vs. 10.7%). From 2001 to 2015, psychotropic prescription overall increased from 4.4% to 7.6%, opioid prescription without coprescription of psychotropics decreased from 11.9% to 8.4%, and opioids with coprescription decreased from 28.1% to 22.0%. Morphine milligram equivalents of 50 or greater per day decreased for women with and without coprescription (29.6% to 17.3% and 22.8% to 18.5%, respectively); MME of 90 or greater per day also decreased in both groups (15.0% to 4.7% and 11.5% to 4.2%, respectively). Women prescribed opioids only were more likely to have an antepartum hospitalization compared with those with neither prescription, as were women with coprescription versus those prescribed psychotropics only. Compared with those prescribed opioids only, women with coprescriptions were more likely to exceed MME of 90 or greater per day and to be prescribed 2 or more opioid agents and for 30 days or longer. Number and duration of opioids increased with benzodiazepine and gabapentin coprescription. Limitation: Inability to determine appropriateness of prescribing or overdose events. Conclusion: Opioids are frequently coprescribed with psychotropic medication during pregnancy and are associated with antepartum hospitalization. A substantial proportion of pregnant women are prescribed opioids at doses that increase overdose risk and exceed daily recommendations

Histologic chorioamnionitis and risk of neurodevelopmental impairment at age 10 years among extremely preterm infants born before 28 weeks of gestation

Background: Extremely preterm infants whose placenta had histologic evidence of chorioamnionitis have early brain dysfunction, but little is known about neurologic development at 10 years of age. Objective: We investigated the association between histologic chorioamnionitis and neurodevelopmental impairment at 10 years among children born 2 standard deviations below the mean), and epilepsy at the age of 10 years by blinded evaluators using validated measures. Multivariable logistic regression with generalized estimating equations was used. Results: Among 805 placentas, 43% (347/805) had histologic chorioamnionitis by moderate or advanced maternal stage, 36% (286/805) by severe maternal grade, 18% (132/737) by moderate or advanced fetal stage, and 1% (10/737) by severe fetal grade. The frequencies of impairments were 11% (88/767) for cerebral palsy, 7% (56/773) for autism spectrum disorder, 15% (120/788) for cognitive impairment, and 7% (52/763) for epilepsy. After adjustment for maternal age, body mass index, race, insurance status, maternal education, tobacco use, infant sex, and multiple gestations, the adjusted odds ratio for the association between histologic chorioamnionitis and cerebral palsy years was increased with advanced maternal stage (adjusted odds ratio, 2.5; 95% confidence interval, 1.6–3.9), severe maternal grade (adjusted odds ratio, 2.0; 95% confidence interval, 1.2–3.4), moderate fetal stage (adjusted odds ratio, 2.20; 95% confidence interval, 2.1–2.2), and mild or moderate fetal grade (adjusted odds ratio, 1.5; 95% confidence interval, 1.0–2.2). Similarly, the adjusted odds ratio for the association between histologic chorioamnionitis and epilepsy was increased with advanced maternal stage (adjusted odds ratio, 1.5; 95% confidence interval, 1.3–1.6) and severe fetal grade (adjusted odds ratio, 5.9; 95% confidence interval, 1.9–17.8). In addition, the adjusted odds ratio for the association between histologic chorioamnionitis and autism spectrum disorder was increased with mild or moderate fetal grade (adjusted odds ratio, 1.7; 95% confidence interval, 1.0–2.9). Histologic chorioamnionitis was not associated with cognitive impairment. These findings held after adjustment for gestational age at delivery. In contrast to histologic chorioamnionitis, a clinical diagnosis of chorioamnionitis was not associated with neurodevelopmental impairment. Conclusion: Histologic chorioamnionitis may be associated with some forms of neurodevelopmental impairment at 10 years of life among infants born <28 weeks’ gestation

Associations between HIV, antiretroviral therapy and preterm birth in the US Women’s Interagency HIV Study, 1995–2018: a prospective cohort

Objective: To evaluate the associations of HIV infection with preterm birth (PTB), and of HIV antiretroviral therapy (ART) with PTB. Methods: We analysed singleton live-born pregnancies among women from 1995 to 2019 in the Women's Interagency HIV Study, a prospective cohort of US women with, or at risk for, HIV. The primary exposures were HIV status and ART use before delivery [none, monotherapy or dual therapy, or highly active antiretroviral therapy (HAART)]. The primary outcome was PTB < 34 weeks, and, secondarily, < 28 and < 37 weeks. We analysed self-reported birth data, and separately modelled the associations between HIV and PTB, and between ART and PTB, among women with HIV. We used modified Poisson regression, and adjusted for age, race, parity, tobacco use and delivery year, and, when modelling the impact of ART, duration from HIV diagnosis to delivery, nadir CD4 count, and pre-pregnancy viral load and CD4 count. Results: We analysed 488 singleton deliveries (56% exposed to HIV) to 383 women. The risk of PTB < 34 weeks was similar among women with and without HIV, but the risk of PTB < 37 weeks was higher [32% vs. 23%; adjusted risk ratio (aRR) = 1.43; 95% confidence interval (CI): 1.07–1.91] among women with HIV. The risk of PTB < 34 weeks was lower among women with HIV receiving HAART than among those receiving no ART (7% vs. 26%; aRR:0.19; 95% CI: 0.08–0.44). The associations between HAART and PTB < 28 and < 37 weeks were similar. Conclusions: Antiretroviral therapy exposure was associated with a decreased risk of PTB among a US cohort of women with HIV. Given the growing concerns about ART and adverse pregnancy outcomes, this finding that ART may be protective for PTB is reassuring

Initiatives and Learnings from World Healthcare Models

International audienceThe global healthcare industry is one of the largest and fastest-growing service industries in the world. The respective benefits of public and private healthcare systems are continually debated, but a third way-that of healthcare cooperatives-is emerging as an alternative method for managing the well-being of the population. There is a growing demand for bringing together successful cases and models of healthcare cooperatives across the world. This chapter focuses on the initiatives of successful healthcare cooperative models from different parts of the world. The chapter highlights the Health cooperative's capability to deliver positive outcomes through healthcare services that are sustained through the collaborative efforts of their members, with remarkable examples and models established in every corner of the world. Such cooperatives provide hospitals and infrastructure, medical facilities, biotechnology, information technology, and all other healthcare services. With this objective, the chapter will help to understand the initiatives in healthcare cooperatives in different parts of the world. © 2024 by Sneha Kumari, V. G. Venkatesh, Priyanka Sunil Kothmire, M. P. Sukumaran Nair and K. K. Tripathy

Introduction: World Healthcare Cooperatives: Challenges and Opportunities

International audienc

World Healthcare Cooperatives: Challenges and Opportunities

International audienceThe healthcare industry is one of the largest and fastest-growing service industries in the world. The respective merits of public and private healthcare systems are continually debated, but a third system - that of healthcare cooperatives - is rapidly emerging as a universal, community-focused and cost-effective alternative. Rooted in remarkable examples from every corner of the world, World Healthcare Cooperatives highlights both the challenges a successful healthcare cooperative may face, as well as its proven effectiveness in making a difference. Understanding that, for many, especially in developing countries, private hospitals and healthcare insurance plans are expensive and out of reach, and that globally many public healthcare systems are under-resourced, chapters demonstrate how healthcare cooperatives have a critical role to play in providing services sustainably and at an affordable cost. Addressing the persistent gap between supply and demand in the healthcare sector, the authors highlight the capability of healthcare cooperatives to create a positive impact. With examples from Canada, Argentina, Japan, Africa, Brazil, Columbia, Sri Lanka, Spain, and India, chapters showcase the services that cooperatives can offer their communities, including the establishment of hospitals, medical facilities, and other infrastructure, as well as opportunities in biotechnology and information technology research. Considering more than 100 million households worldwide that have benefitted from healthcare cooperatives, this pioneering collection triggers a new direction of research to support those seeking to establish healthcare infrastructure in developing and least developed countries in achieving universal healthcare for all. © 2024 K.K. Tripathy, Sneha Kumari, V.G. Venkatesh,All rights reserved. R. Jayalakshmi and M.P. Sukumaran Nair

Not Available

Not AvailableA study was conducted from 2015 to 2018 to find out the sustainability, profitability, energy efficiency and environmental impact of cropelivestock-aquaculture integration in west coast of India. Rice grown in rice-baby corn sequence recorded higher yield than rice-cowpea system. About 4 ton of fodder and 0.7 ton of azolla were produced and recycled as feed to the dairy animals. The household requirements of vegetables and fruits were produced in the kitchen garden (80m2). The farming system recorded energy efficiency, net energy gain, and energy profitability of 2.63, 103311 MJ and 1.63MJ, respectively. The greenhouse gas emission from the system was found to be 10.7 t CO2 eq. and the main contributor to the total emission were enteric methane emissions (24%) from livestock component, diesel consumptions (16%) and N2O emissions mainly from the chemical fertilizers (13%). The percent share of different components to the net return was found higher in cropping systems (40.5%) followed by dairy (37.8%) with an employment potential of 269 man-days/year. The study conclusively reveals that integration of dairy, fishery, poultry components with diversified cropping in coastal lowland ecosystem is essential to offset the ecological imbalances arising due to continuous cultivation of rice crop.Not Availabl